trauma, ptsd & traumatic grief
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DESCRIPTIONCourse Description (From www.PESI.com): Attend this day of training and leave with a brand new toolkit of skills, interventions, and principles for rapid success with traumatized clients. Join Jamie Marich and learn the standard of care for treatment in the field of traumatic stress – and its key ingredients. Implement evidence-based treatment protocols and interventions for establishing safety, desensitizing and reprocessing trauma memories, metabolizing and resolving grief/loss and finally, assisting clients in reconnecting to lives full of hope, connection, and achievement. Jamie is a certified EMDR Therapist and approved consultant through the EMDR International Association (EMDR). She is additionally a member of the American Academy of Experts in Traumatic Stress, the International Association of Trauma Professionals (IATP), and has earned Certification in Disaster Thanatology. Jamie began her career in social services as a humanitarian aid worker in post-war Bosnia-Herzegovina opening her eyes to the widespread, horrific impact of traumatic stress and grief. Objectives: Describe the etiology and impact of traumatic stress on the client utilizing multiple assessment strategies. Assess a client’s reaction to a traumatic event and make an appropriate diagnosis. Explain how grief, bereavement, and mourning are accounted for in the new DSM-5®. Implement interventions to assist a client in dealing with the biopsychosocial manifestations of trauma, PTSD, and traumatic grief/complicated mourning. Utilize appropriate evidence-based interventions to assist a client in dealing with the biopsychosocial-spiritual manifestations of trauma. Explain the effects of trauma on the structure and function of the brain.
- 1. Trauma, PTSD & Traumatic Grief Jamie Marich, Ph.D., LPCC-S, LICDC-CS Youngstown/Warren, OH Affiliate Faculty, International Association of Trauma Professionals @jamiemarich @dancingmindful
2. About Your Presenter Licensed Supervising Professional Clinical Counselor Licensed Independent Chemical Dependency Counselor Affiliate Faculty, International Association of Trauma Professionals (IATP) 13 years of experience working in social services and counseling; includes three years in civilian humanitarian (Bosnia- Hercegovina) Specialist in addictions, trauma, EMDR, dissociation, performance enhancement, grief/loss, mindfulness, and pastoral counseling Author of EMDR Made Simple, Trauma and the Twelve Steps, and Trauma Made Simple (forthcoming) Creator of the Dancing Mindfulness practice 3. What led you to todays workshop? 4. Learning Objectives Describe the etiology and impact of traumatic stress on the client utilizing evaluation tools. Assess a clients reaction to a traumatic event, Acute Stress Disorder and PTSD Explain the DSM-5 changes as they relate to both PTSD and grief- related disorders Implement interventions to assist a client in dealing with the physical manifestations of trauma/PTSD/traumatic grief Utilize appropriate evidence-based interventions to assist a client in dealing with the psycho/socio/emotional manifestations of trauma/PTSD/traumatic grief Explain the effect of trauma on the structure and function of the brain 5. www.traumamadesimple.com/powerpoin t 6. Trauma 7. Once youve been bitten by a snake, youre afraid even of a piece of rope. -Chinese Proverb 8. Etymology What does the word trauma mean? 9. Etymology Trauma comes from the Greek word meaning wound What do we know about physical wounds and how they heal? 10. Etymology Appreciating the wound metaphor is the heart of understanding emotional trauma and how to treat it. 11. DSM PTSD entered into the DSM-III in 1980, largely as a result of the Vietnam War Other names had been used unofficially in the field over the years: soldiers heart shell shock battle fatigue operational exhaustion hysteria 12. DSM-IV-TR Nutshell Definition of PTSD Posttraumatic Stress Disorder (APA, 2000) Actual or perceived threat of injury or death- response of hopelessness or horror (Criterion A) Re-experiencing of the trauma Avoidance of stimuli associated with the trauma Heightened arousal symptoms Duration of symptoms longer than 1 month Functional impairment due to disturbances 13. DSM-5 Nutshell Definition of PTSD Posttraumatic Stress Disorder (APA, 2013) Exposure to actual or threatened a) death, b) serious injury, or c) sexual violation: direct experiencing, witnessing Intrusion symptoms Avoidance of stimuli associated with the trauma Cognitions and Mood: negative alterations Arousal and reactivity symptoms Duration of symptoms longer than 1 month Functional impairment due to disturbances 14. Posttraumatic Stress Disorder: DSM-5 Criteria A. Exposure to actual or threatened death, serious injury, or sexual violence, in one (or more) of the following ways: 1. Directly experiencing the traumatic event(s). 2. Witnessing, in person, the traumatic event(s) as it occurred to others. 3. Learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental. 4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work- related. 15. Posttraumatic Stress Disorder: DSM-5 Criteria B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). (Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.) 2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). (Note: In children, there may be frightening dreams without recognizable content.) 3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) are recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) (Note: In children, trauma-specific reenactment may occur in play.) 4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). 5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).reminders of the traumatic event(s) 16. Posttraumatic Stress Disorder: DSM-5 Criteria C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following: 1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). 2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). 17. Posttraumatic Stress Disorder: DSM-5 Criteria D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs) 2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., I am bad, No one can be trusted, "The world is completely dangerous, My whole nervous system is permanently ruined). 3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. 4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). 5. Markedly diminished interest or participation in significant activities. 6. Feelings of detachment or estrangement from others. 7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings). 18. Posttraumatic Stress Disorder: DSM-5 Criteria E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. 2. Reckless or self-destructive behavior. 3. Hypervigilance. 4. Exaggerated startle response. 5. Problems with concentration. 6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). 19. Posttraumatic Stress Disorder: DSM-5 Criteria F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 20. Posttraumatic Stress Disorder: DSM-5 Criteria Specify whether: With dissociative symptoms: The individuals symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following: 1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, ones mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly). 2. Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted). Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g. complex partial seizures). Specify if: With Delayed Expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate). Subtype: PTSD in children younger than 6 years 21. DSM-5: Trauma & Stressor-Related Disorders Reactive Attachment Disorder Disinhibited Social Engagement Disorder Acute Stress Disorder Posttraumatic Stress Disorder Adjustment Disorders Other Specified Trauma-and-Stressor Related Disorder Unclassified Trauma-and-Stressor Related Disorder 22. Trauma: small-t Adverse life experiences Not necessarily life threatening, but definitely life-altering Examples include grief/loss, divorce, verbal abuse/bullying, and just about everything else The trauma itself isnt the problemrather, does it get addressed? Is the wound given a chance to heal? If it was traumatic to the person, then its traumatic. According to the adaptive information processing model, these adverse life experiences can be just as valid and just as clinically significant as PTSD-eligible traumas. 23. BREAK TIME 24. Worden (2002/2008) Grief is the experience of loss in