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Trauma- PTSD- Well Beingin the immigrant/ refugee

population

By Laura Coogan

Sept 2013

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Trauma

Trauma: Origin of the word in Greek means wound

Psychological definition intentionally does not allow us to determine whether a particular event is traumatic; that is up to each survivor

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Trauma

• The traumatic experience is not in the event but in the person who may have difficulties coping with its impact.

• The negative event may eventually cause overwhelming emotion and a feeling of utter helplessness

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Stress

• Chosen events or circumstances can overwhelm our system.

• Tend to be discharge over a short period of time

• Tend to have a clear meaning (I know why I am so overwhelmed tired, etc)

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From normal reaction to PTSD

“An abnormal reaction to an abnormal situation is normal behavior.” Viktor E. Frankl, Man's Search for Meaning

PTSD occurs when the above “normal” reaction does not extinguish and becomes dysfunctional.

People become “stuck” on the trauma

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'The Diagnostic and Statistical Manual of Mental

Disorders‘(DSM). • PTSD is the only diagnostic category in the DSM

that is based on etiology. In order for a person to be diagnosed with PTSD, there had to be a traumatic event. Because most diagnoses are descriptive and not explanatory, they focus on symptoms or behaviors without a context: they do not explain how or why a person may have developed those behaviors.

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PTSD

Criteria: alterations in arousal and reactivity Trauma-related alterations in arousal and

reactivity that began or worsened after the traumatic event: (2 required)

• Irritable or aggressive behavior. • Self-destructive or reckless behavior. • Hypervigilance. • Exaggerated startle response. • Problems in concentration. • Sleep disturbance.

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PTSD With dissociative symptoms.

• There are situations in which people simply are unable to affect the outcome of events: In the context of child abuse, rape, or political torture, active resistance is likely to provoke retaliation from the perpetrator. In such case, "passive" coping is not maladaptive; sometimes "spacing out" and disengaging can help better.

With delayed expression.• Full diagnosis is not met until at least 6 months after the

trauma(s), although onset of symptoms may occur immediately.

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PTSD

Some survivors engage in high-risk behaviors (present) and activities as unconscious re-enactments of the hyperarousal and adrenaline –infused action during the traumatic events (past)

PTSD and Psychosis

Potential for psychotic symptoms may occur as a comorbidity of chronic PTSD.

These symptoms may include illusions (misinterpretations), hallucinations (hearing, seeing, smelling what is not there) , and dissociative flashback episodes. If delusions (incredible beliefs) do occur, they are primarily paranoid or persecutory in nature. The lack of complex hallucinations, delusions, or formal thought disorder helps differentiate PTSD with psychotic symptoms from schizophrenia or schizoaffective disorder (loss of reality testing).

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Risk Factors for PTSD

• Previous psychiatric illness• Previous exposure to trauma (especially in

childhood)• Duration and magnitude of exposure to

stressors.• Perception of grotesque imagery (especially of

human remains or children).

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Risk factor for PTSD

Most severe if the negative event is: •Human caused •Repeated •Unpredictable •Multifaceted •Sadistic •Undergone in childhood •And perpetrated by a caregiver

PTSD summary

• Stressors trigger massive reactions of fears, helplessness, horror.

• Dissociation: emotional numbing, detachment, reduce environmental awareness, amnesia.

• Intrusiveness: dreams, flash backs, uninvited recollection. Avoidant behavior

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contin,

• Avoidance: decreased interest in the present, feeling of detachment (to provide some safety from the threat of the trauma repetition and the pain attached to it and a sense of extreme vulnerability)

• Hyperarousal, insomnia, irritability, poor concentration, hypervigilance, exaggerated startle response.

• Impairment of social functioning: dysfunctional social behaviours.

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Most common sequeals of PTSD

Tendency to

•Affect dysregulation: intense emotional reactions•Dissociative problems: learning difficulties, memory disturbances•Depression•Difficulty with trust and intimacy

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Well Being/Self-Actualization

“The basic needs of humans must be met (e.g. food, shelter, warmth, security, sense of belongingness etc.) before a person can achieve self-actualization - the need to be fully alive and to find meaning in life”

Abraham Maslow

For successful treatment we need to work with an interdisciplinary team in a cooperative manner.

Spontaneous resources to heal PTSD (religious belief)

• Church attendance is associated with better health due to social support, increase of social network that enable a person to have a sense of belonging (vs. isolation).

• “An interactive relationship with God, cultivated through imagination, in prayers may contribute to good health”

Marie Luhrman

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Differentiating psychotic states from religious experiences

• Details exceed conventional expressions of belief.

• The belief takes over the whole presentation of the client narrative

• Onset of the beliefs marks a change in the client’s life with a deterioration of social skills.

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Healing PTSD (Psychotherapy)

• The therapist may evoke the transitional object (D.W.Winnicot) by acknowledging the client’s pain and responding with care and kindness.

• Supports the person to practice self care and

exploratory curiosity as opposed to self criticism which increases a sense of inadequacy.

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Integration between therapeutic generic approaches to specific culture

• Sharing frame of reference (DBT, CBT, SRT, Gestalt, psychodynamic, psychopharmacology, Narrative therapy, group therapy)

• Asking for frame of reference: what is your healing style, approach, theory, practice?

• Consult with family members or friends as what is their view of the problem/ solution

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Integration between therapeutic generic approach to specific culture

• Clinical urgency (reduce hyperarousal, anxiety-like symptoms, sleepiness, lack of concentration, dissociation)

• Negotiation of priorities• Person’s preferences• Attention to history and social context• Inclusion of language as an essential element of

identity

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Healing PTSD (tools)

• Work in the present moment: What are you noticing vs. what did you notice.

• Trauma is in the nervous system, not the event so renegotiation is taking place in the here and now: What do you notice in your body as you have that thought/memory?

• Use language that keeps the clients in the here and now.

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Healing PTSD (core goals)

• Healing is an invitation for grieving.

(different losses e.g. idealisms)

• Healing is an invitation to accept what it was and what it is (discrepancy between achievement and expectation).

• Re-invention of self.

• Healing leads to making meaning of the traumatic experience.

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Re-invention of self

• “Do not judge me by my successes, judge me by how many times I fell down and got back up again.” ― Nelson Mandela

Conclusion

“Life is never made unbearable by circumstances, but only by lack of meaning and purpose.” ― Viktor E. Frankl

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Interesting…

• “In my country we go to prison first and then become President. ” ― Nelson Mandela

To watch!

Mr. Happy Man - Johnny Barneshttp://youtu.be/v_EX5NzqNXc

Kung Fu 1972/ season 1-episode4)

http://youtu.be/IKH4nY4WlFY

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