Julian D. Ford, Ph.D.Judith Ford, M.A.

Copyright © 2001 by the University of ConnecticutAll rights reserved.

No part of this work may be copied or distributedwithout prior written permission.

What is PTSD?• POST: After

• TRAUMATIC: A Threat to Your Survival

• STRESS: Brain’s Alarm System

• DISORDER: Unable to meet your goals

• PTSD: Survival Skills Keep the Brain’s Stress Alarm Constantly Turned On

TraumaDepression

Irritability

Decreased interest

Numbing

Decreased concentration Insomnia

Physiological hyperarousal Psychomotor

agitation

Foreshortened future

Hopelessness

Depersonalization Derealization

Identity disturbance

Substance abuse Eating disorders

Somatization

Generalized anxiety Panic

attacksFlashbacks

Nightmares

Startle Hypervigilence

Intrusive memorie

s

Amnesia

PTSD

Major Depression Anxiety Disorder

Self-destructive behavior

Borderline Personality

Bremner & Marmer, 1998

Trauma Affect Regulation: Guide for Education & Therapy

FREEDOM STEPS

Seven skills ~

Designed to engage theFiling & Thinking Centers to:

Counteract the bodily reactivity, mental confusion, emotional distress, and social isolation caused by PTSD.

Anterior MEDIAL Posterior Front Middle Rear

Top(Dorsal)

Bottom(Ventral)

Pre-Frontal Cortex Amygdala Hippocampus

Anterior Cingulate

Alarm

Filing Center

Orient- ing Center

Thinking Center

SOS: Three Steps to Focusing

• Step I: Slow Down – Take a Time Out; Calm Your Body;

One Thought at a Time

• Step II: Orient Yourself – Notice your surroundings – where you

are and who is with you; – Focus on something of interest that you

can see or hear

• Step III: Self Check – How Much Stress? How Much Control?

What Is an Alarm Trigger?

• Reminder of a past traumatic memory

• Based on specific aspects of trauma

• Turns on the alarm & sends a signal that something terrible is happening now

Peanuts Classics ®

Peanuts Classics ®

Peanuts Classics ®

Peanuts Classics ®

recognizing triggers

• We respond to triggers/cues regularly; however, triggers that cause alarm reactions send a message to the brain that the threat is immediate and real.

• Recognizing triggers in advance makes it possible to use Filing and Thinking Centers and prevent or manage alarm reactions.

• Helping clients to recognize personal triggers increases the likelihood of allowing for a response rather than a reaction.

• Recognizing triggers increases sense of personal control.

recognizing triggers

REACTIVE Emotions

“Charged” Emotions– Flash of anger– Wave of grief– Paralyzed with

guilt– Frozen with fear

Shutdown Emotions– Shock– Numb– Withdrawn– Discouraged

MAIN Emotions, Thoughts, Goals• Allows evaluation and choice

• Measured

• Flexible

• Manageable

• Hopeful

• Confident

• Empathic

• Cooperative

Reactive/Main Thoughts

REACTIVE

• Loud

• In your face

• Demand action

• Promise instant gratification

MAIN

• Quiet

• In the background

• Require stepping back

• Hold out genuine gratification

REACTIVE/MAIN goalsREACTIVE

• Getting away from danger

• Making it through the immediate situation

• Evening the score

MAIN

• Doing worthwhile things right now

• Achieving a good and meaningful life

• Building relationships

ExampleStressor: I was betrayed • Alarm Reaction

– Emotion: Rage– Thought: I can’t trust anyone– Goal: I’m going to keep my distance from

everyone so I don’t get betrayed again.

• Self Regulation – Emotion: Confidence – Thought: I need to find someone trustworthy &

trust myself– Goal: I’m going to build relationships in which

I’m respected and loved

Example

• Stressor: I said hurtful things to a friend

• Alarm Reaction– Emotion: Ashamed– Thought: I’m a bad person– Goal: I’m going to give up this friendship

• Self Regulation– Emotion: Determined– Thought: I need to learn from my mistakes and

make good choices– Goal: I’m going to ask for help and keep trying

MAIN Emotions, Thoughts, Goals

Can you…

Evaluate the situation,

and

Choose what is really important to you?

Identifying your good intentions activates your

Thinking Center and turns down the Alarm.

As the Alarm is turned down, you are able to

recognize a wider range

of Options.

Example

• Alarm reactions/options:• Yelling at someone• Giving up • Trying to make it all work out instantly

• Positive options:• Listening and working out a solution• Finding a new way to try again• Taking one step at a time

Making a contribution is turning down the alarm to recognize the true ways the client is making a difference in her/his life and the life of others at the present moment.

“You cannot teach a man anything; you can only help him find it within himself.”

- Galileo (1564 –1642, Italian astronomer and mathematician)