Crisis intervention strategies chapter 7

MANY CRISES MAY BE ROOTED IN PTSD... DIAGNOSING PTSD DSM-IV-TR, APA 2000First see page 152: * Person Exposed to a trauma/event that involved actual or threatened death or serious injury

Chapter 7 - Posttraumatic Stress Disorder

MANY CRISES MAY BE ROOTED IN PTSD

DIAGNOSING PTSD (DSM-IV-TR, APA 2000)

First (see page 152):

* Person Exposed to a trauma/event that involved

actual or threatened death or serious injury, or a threat

to self or other's physical well-being.

* Response is intense fear, helplessness, or horror

DIAGNOSING PTSD (DSM-IV-TR, APA 2000)

Second (see page 152):

* Person persistently re-experiences the traumatic event in at least one

DIAGNOSING PTSD (DSM-IV-TR, APA 2000)

Third (see page 152):

* Person persistently avoids such stimuli in at least three

of the following:

1 Thoughts, dialogues, or feelings about trauma

2 Activities, people, or situations about trauma

3 Inability to recall important aspects of trauma

4 Diminished interest in significant activities

DIAGNOSING PTSD (DSM-IV-TR, APA 2000)

Fourth (See page 152)

* Person has increased nervous system arousal as indicated by at least two of the following:

1 Difficulty falling or staying asleep

2 Irritability or outbursts of anger

3 Difficulty concentrating on tasks

4 On Watch for real or imagined threats

5 Startle reactions to minimal or non-threatening stimuli

DIAGNOSING PTSD (DSM-IV-TR, APA 2000)

Fifth (see page 152):

* Person has clinically significant distress or

impairment in social, occupational, or other

critical areas of living

* For more than one month

* About 8% for general civilians

* About 20% after a trauma

* Higher for at risk groups:

1 Adolescents and young adults

2 People in hazardous occupations

3 Sexual assault victims

4 Severe burn cases

5 Psychiatric cases

6 Refugees

7 War vets can be much higher.

WAR VETS - TERMS

5 MALADAPTIVE PATTERNS OF PTSD

1 Death Imprint (continuing identity with death and

sensation-seeking behaviors)

2 Survivors Guilt

3 Desensitizing oneself to totally unacceptable events, and

then trying to return to a semblance of normalcy in a

peaceful world (bipolar emotions)

4 Estrangement (from relationships and/or social services)

5 Emotional enmeshment (fixation on trauma keeps them

from successful relationships/family functioning

TODAYS WAR VETS/SOLDIERS

3 COMPONENTS OF PTSD TREATMENT OF ADULTS

1. Processing and coming to terms with the

experience

2. Controlling physiological and biological

stress reactions

3. Reestablishing secure social connections

and interpersonal efficacy

3 GOALS IN ASSESSMENT FOR PTSD

ADULTS

1. Are PTSD symptoms present?

2. Are drugs or personality disorders masking

PTSD?

3. How is the event contextually interpreted by

the person?

ASSESSMENTS FOR PTSD

PTSD Scale - CAPS-1, based on DSM-IV-TR)

Traumagram Questionnaire

population based)

PHASES OF RECOVERY FOR PTSD

1 The emergency or outcry phase (fight or flight)

2 The emotional numbing and denial phase (avoidance)

3 The intrusive-repetitive phase (nightmares, volatile mood

swings, intrusive images, etc) - Now seeking help.

4 The reflective-transition phase (better perspective, coming

to grips)

5 The integration phase (successfully integrates the trauma

with other past experiences and restores a sense of

continuity to life.

PSYCHOTROPIC MEDICATION

1. Some relief of psychophysiological

responses

2. Prozac (antidepressant)

3. Clonidine (decrease arousal)

4. Requires careful prescription and monitoring

with expertise

GROUP TREATMENT TYPES

and typically for acute like-distress survivors of

a common traumatic experience)

composed of class-specific members who

have been exposed to the same type of trauma but at different times and under different

circumstances.)

PTSD GROUPS (2 PHASES)

1. Focus on accessing and working through the

trauma and its symptoms

2. Life Adjustment Group - Focus on the

readjustment to contemporary society

(Behavioral change, coping, family etc.)

PTSD AND CHILDREN

1. US, 30 to 50% will experience at least one

traumatic event by 18th birthday

2. US, 1 million cases (homegrown) child

abuse per year

3. Of those with at least one trauma (3-16%

girls, 1-6% boys) will develop PTSD

PTSD AND CHILDREN - TYPE OF TRAUMA

parent killed or sexually assaulted

PTSD AND CHILDREN - TREATMENT

1. Depends on developmental stage

2. and Cognitive ability

3. Adult diagnosis is not the same (DSMs no

longer captures what fits for children)

4. Support system is critical

5. Separation carries emotional and personality

disturbance

TYPES OF CHILDHOOD TRAUMA

considered

(detailed fully etched-in memories, misperceptions, mistiming of the event, etc.)

traumatic ordeals (psyche's developing defensive and coping strategies to ward off the assaults -

such as denial, dissociation, repression psychic

numbing, self aggression etc.)

TREATMENT OF CHILDHOOD PTSD

1. Early assessment is critical

2. Interviewing helps reduce long-term

symptoms (but parents may be resistant)

3. Requires great skill with both

Cogitive-Behavioral Therapy and Play Therapy

EMDR (ADULTS AND CHILDREN)

1. Eye Movement Desensitization and

Reprocessing

2. Controversial

3. Requires specialized training