This chapter aims to help clinicians learn stabilization interventions for use in the Preparation Phase of eye movement desensitization and reprocessing (EMDR) treatment. Using these interventions will aid clients in developing readiness for processing trauma, learning how to manage symptoms of dissociation, dealing with affect regulation, and developing the necessary internal cohesion and resources to utilize the EMDR trauma-processing phase. Earlier negative experiences stored dysfunctionally increase vulnerability to anxiety disorders, depression, and other diagnoses. When assessing a client with a complex trauma history, clinicians need to view current symptoms of post-traumatic stress disorder (PTSD) or depression as reflections of the earlier traumas. The chapter outlines the strategies dealing with dissociative symptoms, ego state work, and internal stability that help clinicians to develop an individualized treatment plan to successfully guide the client through the EMDR phases of treatment.
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- Go to chapter: Stabilization Phase of Trauma Treatment: Introducing and Accessing the Ego State System
- Go to chapter: A Developmentally Grounded and Integrative Clinical Approach for Treating Complex Trauma and Dissociative Disorders in Children
A Developmentally Grounded and Integrative Clinical Approach for Treating Complex Trauma and Dissociative Disorders in Children
Children are exposed to distress, violence, and trauma even before they are born. In-utero and early childhood exposure can contribute to severe medical and psychological consequences. Children who have been exposed to such traumatic events often arrive at the psychotherapist’s office with emotional and behavioral symptoms suggestive of reactive attachment disorder (RAD), post-traumatic stress disorder (PTSD), and dissociation. This chapter reviews relevant theories of dissociation integrated with theories of development to provide a summary of how attachment impacts dissociation. With a developmentally grounded theory of dissociation, the chapter describes clinical interventions for treating the dissociative sequelae of attachment trauma in children. This theoretical framework offers a developmentally grounded and integrative framework for working with children with complex trauma and dissociation. Symptoms of dissociation are common with PTSD, but an extreme response to trauma can be dissociation and dissociative disorders.
This chapter describes the toxic stress often experienced by young homeless children and the effect that this type of stress can have on brain development, behavior, and lifelong health. Mental health and cognitive challenges are abundant among homeless families. Stress can affect maternal cardiovascular function and restrict blood supply to the placenta, potentially reducing fetal nutritional intake or oxygen supply, and lead to reduced fetal growth, increased risk of placental insufficiency, preeclampsia, and preterm delivery. Trauma in early childhood has clear neurological and developmental consequences, especially with regard to brain development and executive functioning. The chronic release of two stress hormones glucocorticoids and cortisol can have damaging effects on neurological functioning and lifelong health. Similarly, exposure to high levels of cortisol inhibit neurogenesis in the hippocampus, further impacting executive functioning and the ability to distinguish safety from danger, a symptom of posttraumatic stress disorder (PTSD).
This chapter describes maneuvers to access the internal system of the patient as well as means to accelerate or decelerate the work in that process of accessing the self-system. Eye movement desensitization and reprocessing (EMDR), ego state therapy, and somatic therapy fit together like hand and glove. An extended preparation phase is often necessary before trauma processing in complex traumatic stress presentations and attachment-related syndromes, particularly when dealing with the sequelae of chronic early trauma. Clinical practice suggests that the adjunctive use of body therapy and ego state interventions can be useful, during stabilization and later on in increasing the treatment response to EMDR. Traditional treatment of complex posttraumatic stress disorder (PTSD) and dissociative disorders has usually included hypnoanalytic interventions, during which abreaction is considered an important part of treatment.
This chapter discusses the impact of trauma and its treatment through discussion of posttraumatic stress disorder (PTSD) and its neurological components-especially those affecting memory, evidence-based therapies (EBTs) for the treatment of PTSD, and the implications for practice, policy, and research. Two primary predictors exist for a person developing PTSD. The first one is experiencing dissociation during the trauma. The second predictor is the person developing acute stress disorder. Specifically, neuroimaging shows how PTSD affects neurological functioning in the brain. The primary regions of the brain affected by PTSD are the medial prefrontal cortex, the left anterior cingulate cortex, the thalamus, the medial temporal and hippocampal region, and the amygdala. The different regions of the brain associated with memory encoding are: left prefrontal cortex, left temporal/fusiform, anterior cingulate, and hipocampal formation. Cognitive-behavioral therapy (CBT) has been used extensively to treat PTSD.
This chapter focuses on identifying and working with dissociative symptoms and dissociative disorders in a therapeutic context, providing a road map to assist with the pacing and planning of clinical interventions. Rapid eye movement (REM) sleep can be conceptualized as a household strength processor that can accommodate the usual processing requirements of daily life. Posttraumatic stress disorder (PTSD) has been historically defined as requiring a trauma that is outside the range of normal human experience. Hypoarousal and parasympathetic activation that are an intrinsic part of dissociative symptoms are much more difficult to assess. The original painful memories live on in flashbacks and nightmares as well as in reenactments of the unconscious dynamics captured from the family of origin’s enactments of perpetration, victimization, rescuing, and neglect. Excessive sympathetic nervous system activation is easily construed to be an indicator of psychopathology.
This chapter reviews the disturbances in self-referential processing and social cognition in posttraumatic stress disorder (PTSD) related to early-life trauma. It talks about the neural underpinnings of self-referential processing and examines how they may relate the integrity of the default mode network (DMN). The chapter describes the deficits in social cognition, with a particular focus on theory of mind in PTSD and the neural circuitry underlying direct versus avert eye contact. It then addresses the implications for assessment and treatment. Johnson demonstrated that self-referential processing is associated with the activation of cortical midline structures and therefore overlaps with key areas of the DMN in healthy individuals. Healthy individuals exhibited faster responses to the self-relevance of personal characteristics than to the accuracy of general facts. Less activation of the medial prefrontal cortex (PFC) was observed for the contrast of self-relevance of personal characteristics relative to general facts as compared to controls.
This book was conceived out of the authors' shared vision to synthesize key neurobiological developments with effective developments in clinical practice to offer both understanding and practical guidance for the many practitioners working to heal people burdened with traumatic sequelae. It is unique in bringing in all levels of the brain from the brainstem, through the thalamus and basal ganglia, to the limbic structures, including the older forms of cortex, to the neocortex. The book looks at the neurochemistry of peritraumatic dissociation (PD) and explores the effects on neuroplasticity and the eventual structural dissociation. Individual chapters focus on the definition of PD and tonic immobility (TI) and their associations with posttraumatic psychopathology, and review disturbances in self-referential processing and social cognition in posttraumatic stress disorder (PTSD) related to early-life trauma. Separate chapters focus on the modulatory role of the neuropetides in attachment as well as autonomic regulation, and highlight mesolimbic dopamine (ML-DA) system as central to the experiences of affiliation, attachment urge when under threat, attachment urge during experience of safety, and to the distress of isolation and/or submission. The book while increasing awareness of different parts of the self and ultimately creating a more stable sense of self, also incorporates psychoanalytic, cognitive behavioral, and hypnotic methods, as well as specific ego state, somatic/sensorimotor therapies, eye movement desensitization and reprocessing (EMDR), and variations of EMDR suitable for working with trauma in the attachment period. The latter methods are explicitly information-processing methods that address affective and somatic modes of processing.
This chapter provides information for therapists to integrate theories of neuroscience into the practice of child psychotherapy. Neuroscientists have described how the brain develops, documented the impact of external experiences on the developing brain, and integrated theories of neurodevelopment and neuroplasticity into our understanding of the impact of our interpersonal relationships on our brain. The chapter focuses on developmental trauma disorder and the research on the impact of trauma on children. The majority of the research on trauma in children has focused on the assessment and diagnosis of Post traumatic stress disorder (PTSD); however, there are a limited number of studies that have documented the efficacy of the treatment of PTSD in children. The chapter reviews diagnoses specific to neurodevelopment, including autistic spectrum disorders (ASD) and sensory processing disorders (SPD).
The current common combat era casualties have been posttraumatic stress disorder (PTSD), head injuries, hearing loss or impairment, and polytrauma. Common causes of military traumatic brain injuries (TBI) are blasts, falls, vehicular accidents, and penetrating fragments or bullets. Mild TBIs (mTBIs) usually are not detectable by lab tests or scans, which typically show normal results. The most common assessment instrument used for TBI is the Glasgow Coma Scale, which scores eye opening responses, motor responses, and verbal responses. Findings of effectiveness of psychosocial rehabilitation models for civilians with TBI and their families suggest that developing models of supported education and employment for injured veterans may be similarly helpful. Stigma, military stoicism, mTBI-related executive function compromise, and PTSD-related avoidance symptoms are barriers to care for neurological disorders, but disclosure of care is still perceived as possibly leading to loss of career or current employment, both among active duty and veterans.
This book serves as a practice resource for social workers by making accessible the vast territory covered by the social, cognitive, and affective neurosciences over the past 20 years, helping the reader actively apply scientific findings to practice settings, populations, and cases. It features contributions from social work experts in four key areas of practice: generalist social work practice; social work in the schools and the child welfare system; in health and mental health; and in the criminal justice system. Each of the chapters is organized around practice, policy, and research implications, and includes case studies to enhance practice application. The impact the environment has on neural mechanisms and human life course trajectories is of particular focus. It is divided into four sections. Section A includes chapters devoted to social-cognitive neuroscience conceptualization of empathy, mirror neurons, complex childhood trauma, the impact of trauma and its treatment through discussion of posttraumatic stress disorder (PTSD). Section B covers child maltreatment and brain development, transition of youth from foster care, social work practices in schools for children with disabilities, and managing violence and aggression in school settings. Section C deals with several issues such as substance abuse, toxic stress and brain development in young homeless children and traumatic brain injuries. Neuroscientific implications for the juvenile justice and adult criminal justice systems are explained in Section D.
This chapter focuses on self-care for Eye Movement Desensitization and Reprocessing (EMDR) practitioners. The protocol was derived from the notes of Neal Daniels, a clinical psychologist who was the director of the posttraumatic stress disorder (PTSD) Clinical Team at the Veterans Affairs Medical Center. In Dr. Daniels’s words, the procedure is short, simple, effective. Right after the session or later on in the day when it is possible, bring up the image of the patient, do 10–15 eye movements (EMs); generate a positive cognition (PC) and install it with the patient’s image, and do 10–15 EMs. Once the negative affects have been reduced, realistic formulations about the patient’s future therapy are much easier to develop. Residual feelings of anger, frustration, regret, or hopelessness have been replaced by clearer thoughts about what can or cannot be done. Positive, creative mulling can proceed without the background feelings of unease, weariness, and ineffectiveness.
Sexual trauma includes any type of physical touching or other activity of a sexual nature that is against our will or done without our consent. This chapter defines sexual trauma as anything that occurred or was threatened to occur that was experienced as a violation of a sexual nature. Sexual trauma occurs in many different forms and any sexual trauma can be deeply wounding, requiring new skills for healing. Military sexual trauma (MST) refers to experiences of sexual trauma that occur while a person is serving on active duty military service. The link between MST and homelessness is a perfect example of accumulated symptoms. MST was related to symptoms of posttraumatic stress disorder (PTSD). Forced sex may be viewed as an act of domination to inflate one’s sense of self-importance or power. Psychological symptoms include negative thought patterns such as negative thinking, negative thoughts around trust, safety, and self-blame.
- Go to chapter: Protocol for Releasing Stuck Negative Cognitions in Childhood-Onset Complex Post-Traumatic Stress Disorder (C-PTSD)
Protocol for Releasing Stuck Negative Cognitions in Childhood-Onset Complex Post-Traumatic Stress Disorder (C-PTSD)
This protocol was developed to help clients with childhood-onset complex post-traumatic stress disorder (PTSD) who have difficulty moving from the negative cognition (NC) to the positive cognition (PC) and instead, experience persistent looping. Packed dilemmas usually require and respond to a protocol comprising a particular sequence of Socratic cognitive interweaves (CI), which disentangles two clusters of confusion in turn: first, responsibility and entitlement, and then responsibility and loyalty. Ordinarily, as eye movement desensitization and reprocessing (EMDR) therapists, the authors attempt to stay out of the way of the client’s processing, and since CIs can influence processing, they use them sparingly. In a packed dilemma, however, they may need to influence the processing because the family attachment patterns are woven into issues of responsibility, which contribute to the embedded immobility of the NC.
Eye movement desensitization and reprocessing (EMDR) Standard protocol connects a trauma model of relationships to Bowen’s concept of differentiation. In addition to those couples where a traumatic episode, prior to or during the relationship, has had a clear impact on the relationship, highly reactive couples are those who profit most from integrating EMDR into their couples work. EMDR can play an important role when reactivity in sessions blocks therapist interventions or resists routine interventions; when one or both partners are so reactive as to be abusive. When EMDR is used to treat trauma, therapists generally look for treatment change specific to the trauma and its posttraumatic stress disorder (PTSD)-like symptoms. In couples therapy, the desired outcomes are more the generalized effects of EMDR and those we might expect from EMDR performance enhancement.
Different experiential, psychophysiological, and neurobiological responses to traumatic symptom provocation in post-traumatic stress disorder (PTSD) have been reported in the literature. The term bottom-up processing is used in sensorimotor psychotherapy, a somatic approach to facilitate processing of unassimilated sensorimotor reactions to trauma. Lanius found this approach useful in dealing with dissociative symptoms and adapted it to be used in conjunction with bilateral stimulation (BLS), as part of a comprehensive treatment approach for individuals with complex post-traumatic stress disorder (C-PTSD) and dissociative symptoms. When we use the Standard eye movement desensitization and reprocessing (EMDR) Protocol, we work with sensorimotor, emotional, and cognitive aspects of information. Bottom-up processing is a way to work with issues of dissociation. Traumatic memories appear to be timeless, predominantly nonverbal, and imagery-based. Somatic memory is an essential element of traumatic memory; trauma memories, at least in part, are encoded at an implicit level.
This chapter looks at dissociation, psychosis, and schizophrenia from a phenomenological standpoint. Phenomenology is the lens through which psychiatrists look at mental illness, and psychiatry as a specialty has looked at people in this way from its earliest days. In taking a phenomenological view of dissociation and psychosis, the chapter reiterates some of the dissonance brought by Laing when he invited people to understand schizophrenia as a theoretical model and not a biological entity. Extreme dissociation is the most primitive form of survival, where a human being is confronted with events that are impossible to process. Treating schizophrenia by formulating it within a trauma and dissociation paradigm allows for the application of eye movement desensitization and reprocessing (EMDR) therapy, which is one of the current international gold-standard psychotherapies for posttraumatic stress disorder (PTSD).
This chapter covers psychiatric diagnoses that might be applied to children seen in primary care: pediatric bipolar disorder, major depression, attention deficit hyperactivity disorder (ADHD), and posttraumatic stress disorder (PTSD). It discusses the diagnoses of the context in the neuroscience explaining the disorder. The chapter reviews the efficacy of current pharmacological treatments along with explanations regarding how they impact physiology, and considers side effects. It also provides alternatives to drugs administered for distress in the children themselves. The profile of adults with bipolar I differs dramatically from the behavioral pattern of children being diagnosed as having pediatric bipolar disorder. The Food and Drug Administration (FDA) has approved fluoxetine/Prozac for the treatment of depression in children. Antidepressants carry an FDA black-box warning for suicidal ideation in children and adolescents. Stimulant drugs are the mainstay of treatment for ADHD. The number of children in foster care receiving antipsychotic drugs is particularly notable.
This chapter helps the reader to understand the justifiable optimism when applying eye movement desensitization and reprocessing (EMDR) therapy to psychosis and to equip clinicians with the skills to identify those people experiencing psychosis who are most suitable for EMDR therapy. The adaptive information processing (AIP) model and the dysfunctional memory network (DMN) are paradigms that have validity beyond posttraumatic stress disorder (PTSD); they are just as valid for addictions, obsessive-compulsive disorder, depression, and psychosis. The chapter explores the people who are suitable for EMDR therapy for psychosis, using the Indicating Cognitions of Negative Networks (ICoNN) model, in two groups: first, people with psychosis who have a clear trauma history or comorbid PTSD; and second, those who meet current criteria for schizophrenia within the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) classification systems in addition to the proposed criteria for dissociative schizophrenia.
The eye movement desensitization and reprocessing (EMDR) method represents a significant advance in psychotherapy. While most of the empirical research on EMDR demonstrates its efficacy as a treatment for posttraumatic stress disorder (PTSD), including relational traumas. Dysfunctional patterns of relating in the family of origin can imprint themselves on the relational template of adults, only to be reenacted in the contemporary couples relationship. Because EMDR can be effective at transforming these earlier relational traumas, adults can become less reactive, enjoy greater distress tolerance, and have a more resilient ego boundary. Thus, EMDR is an invaluable tool in couples therapy. A 5-step protocol is proposed that can guide therapists to develop an EMDR treatment plan within the context of couples therapy. This protocol can and should be applied to both partners in most cases, but of necessity, the therapist must choose one partner to begin with.
This chapter provides the reader with a working knowledge of the relationship between trauma, schizophrenia, and the other psychoses. Trauma and its consequences have been a part of society for a very long time. The psychological impact of the trauma of war became most widely known as “shell shock” in World War I. Wartime features heavily in the development of the nomenclature of the psychological impact of trauma. Posttraumatic stress disorder (PTSD) is the archetypal response to a traumatic event, and the concept soon expanded from the military to all of society as potential sufferers. The evolution of the diagnosis of schizophrenia was characterized by a move away from a trauma/dissociation model and toward a biological diathesis model, which resulted in schizophrenia’s phenomena being viewed as psychologically incomprehensible. There is no single cause of psychosis, just as there is no single gene.
- Go to chapter: The Wreathing Protocol: The Imbrication of Hypnosis and EMDR in the Treatment of Dissociative Identity Disorder, Dissociative Disorder Not Otherwise Specified, and Post-Traumatic Stress Disorder
The Wreathing Protocol: The Imbrication of Hypnosis and EMDR in the Treatment of Dissociative Identity Disorder, Dissociative Disorder Not Otherwise Specified, and Post-Traumatic Stress Disorder
The Wreathing Protocol has been designed as a thorough, planful, and parsimonious way to protect trauma patients from decompensation during the middle phase of trauma. It presumes sophistication and fluency on the part of the clinician who ought to be skilled in advanced hypnosis techniques, ego state therapy, and controlled fractionated abreactions without the use of formal hypnosis or eye movement desensitization and reprocessing (EMDR). To best illustrate the discrete interventions amidst the complexity of dissociative responses, the operationalized EMDR protocols will be exemplified in the paradigmatic dissociative disorder, dissociative identity disorder (DID); however, they also apply for lesser dissociative disorders, dissociative disorder not otherwise specified (DDNOS) and post-traumatic conditions particularly when using an ego state model as an organizing principle in the treatment. Wreathing Protocol represents a skeletal structure around which complex dissociated elements of personality can regroup, blend, and integrate after detoxification and transformation of the traumatic material.
This chapter focuses on anxiety disorders and deals with a discussion of the physiology of anxiety, including the major structures involved in the creation of a fear memory. It considers the mechanisms for extinction of conditioned anxiety. The chapter discusses the basic physiology of fear conditioning, specific anxiety disorders namely generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD), and explains treatments. It then reviews the literature about how clients can talk about their fears to minimize them and how relabeling or reappraising of past events can be helpful. There is evidence suggesting that the basal ganglia, structures associated with the control of movement, are involved in the expression of OCD behaviors in subsets of those with OCD. Cognitive behavioral therapy is effective in the treatment of generalized anxiety. Selective serotonin reuptake inhibitors are also used in the treatment of anxiety disorders.
The standard Safe Place Protocol uses a word for cuing and self-cuing. For the last 3 years, the author has used olfactory stimulation with more than 30 children and adolescents to cue the Safe Place and resources installed with the Resource Development and Installation (RDI) Protocol. The effectiveness of olfactory cues to assist traumatized children in accessing previously installed resources for self-regulation may be associated with the relationship between trauma and thalamic activity. Individuals with simple post-traumatic stress disorder (PTSD) might show an increase in thalamic activity and those with complex PTSD, a decrease in thalamic activity. For many years, aromatherapy has been used as an adjunctive form of therapy in mental health. Before establishing the Safe Place, it is important that you explain to the child and the caregivers what eye movement desensitization and reprocessing (EMDR) is and how it works, especially the different forms of bilateral stimulation (BLS).
Suris, Lind, Kashner, and Borman surveyed 89 female participants who reported a history of military sexual trauma (
MST) and reported that “all of the respondents endorsed some amount of sleep difficulty”. Woods, Hall, Campbell, and Angott examined relationships among interpersonal violence, posttraumatic stress, and physical symptoms in a sample of women and found that different types of sleep complaints were among the most frequently reported problems and that they were significantly correlated with having experienced sexual violence. Traditionally, insomnia has been associated with posttraumatic stress disorder (PTSD), and every version of the diagnostic criteria for PTSD contains some version of disturbed sleep. This chapter recommends a thorough assessment of medical and psychological comorbidity as well as trauma history to identify factors that may affect sleep. Chronic pain should be reviewed with the patient’s primary care physician for possible medication changes that can alleviate pain and improve sleep.
This chapter explores vicarious trauma, compassion fatigue, and burnout and the potential impact on professionals who treat victims of military sexual trauma (
MST). Professionals who provide counseling to sexual trauma survivors will be affected by the exposure to the personal and, sometimes, graphic accounts of sexual victimization reported by their clients. Although brief exposure to extreme or shocking trauma material can have a significant impact on the helping professional, prolonged exposure to emotional pain and the explicit details of other people’s suffering can be more problematic. Psychologist Jacob Lindy pointed to this concern in his book on treating war veterans with posttraumatic stress disorder (PTSD). Burnout was originally used in the 1970s by psychoanalyst Hebert Freundenberger in reference to occupational exhaustion. Burnout may involve psychological, physical, or behavioral symptoms in both personal and professional settings.
The neurobiology of posttraumatic stress disorder (PTSD) and the effects of lifetime trauma on an individual have been covered extensively in the literature over the past two decades. This chapter reviews some of the relevant trauma-related neurobiology literature as it applies to military sexual trauma (
MST), both in men and in women. The presentation of premilitary factors is structured around three major areas in the neurobiology of traumatic stress: early life trauma and the emergence of the emotional response; lifetime cumulative effect of trauma and the hypothalamic pituitary axis (HPA); and additional factors contributing to long-term vulnerability or resiliency. The brain and behavioral patterns are molded in parallel with early life experience. When a child develops the ability to recall events, he or she experiences the beginning of autobiographical memory. Primary affective states originate in the reticular activating system (RAS) of the brain.
- Go to chapter: Prolonged Exposure and Cognitive Processing Therapy for Military Sexual Trauma–Related Posttraumatic Stress Disorder
Prolonged Exposure and Cognitive Processing Therapy for Military Sexual Trauma–Related Posttraumatic Stress Disorder
This chapter discusses the main treatment components of cognitive processing therapy (CPT) and prolonged exposure (PE) and provides evidence for CPT and PE, and highlights common clinical issues seen in patients with military sexual trauma (
MST) related posttraumatic stress disorder (PTSD). Janoff-Bulman posits a model of PTSD in which trauma is conceptualized as “an emotional shock” that shatters beliefs about safety and self-worth. Therapeutic techniques derived from several theories typically process the traumatic memory so that individuals can integrate it into their autobiographical memory base, identify and modify maladaptive trauma-related beliefs, and decrease cognitive, emotional, and behavioral avoidance. In clinical trials, PE demonstrates consistently large clinically meaningful changes across PTSD, depression, anxiety, and functioning in heterogeneous trauma-exposed samples including sexual assault survivors and veterans.
Emotional dysregulation is a key component of posttraumatic stress disorder (PTSD). It is important to understand the basic neurophysiology of stress and how it influences a survivor’s ability to cope. The mechanism involved in stress includes the connections among the hypothalamus, the pituitary gland, and the adrenal gland. Glucocorticoids influence metabolism and immune function, and send signals back to the brain about the stressor. Low cortisol levels immediately after a trauma may also be a risk factor for developing PTSD. The sympathetic nervous system (SNS) secretes catecholamines during stress, which help to consolidate memories. When military personnel have a history of childhood abuse and subsequent military sexual trauma (
MST), they may be particularly vulnerable to developing PTSD. Anticipatory anxiety is also one of the greatest barriers in engaging clients in treatment. Mindfulness can be described as any practice that brings clients back to the present moment.
Somatic experiencing (SE) has emerged from a long tradition of somatic education and body-oriented psychotherapy. When the body successfully implements the planned action sequence and adequately releases the remaining unused survival energy, the person regains equilibrium and does not encounter the physiological sequelae associated with trauma. The person then moves from acute arousal into a state of chronic arousal and generalized dysfunction in the central nervous system. SE draws upon the neurobiological study of the multidirectional interconnection between the body, brain, and mind. Posttraumatic stress disorder (PTSD) and the symptom clusters associated with the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders illustrate the body’s “stuck energy”. Treating survivors of military sexual trauma (
MST) introduces a unique set of circumstances. In the military, unit cohesion is synonymous with safety and survival.
This chapter offers a summary of the Seeking Safety Model, which is designed to address both posttraumatic stress disorder (PTSD) and substance use disorder (SUD). It focuses in particular on its relevance to military sexual trauma (
MST). Conventionally, most SUD treatment programs focused on attaining stabilization or abstinence before addressing mental illnesses. Seeking Safety is an evidence-based therapy that has been widely used to treat people with a history of trauma and substance abuse. The primary goal of Seeking Safety is to encourage client safety by building coping skills in relation to both trauma and substance abuse. Seeking Safety offers 25 topics that address cognitive, behavioral, and interpersonal skills. A clinician’s report says that veterans appear to be more difficult to engage in treatment than other groups. The Seeking Safety approach is a low-cost model that was designed for public-health relevance, which can be implemented across all levels of care.
- Go to chapter: Evidence-Based Interventions to Support Youth Following Natural Disasters: Evidence-Based Principles and Practices
Evidence-Based Interventions to Support Youth Following Natural Disasters: Evidence-Based Principles and Practices
This chapter discusses issues associated with specific natural disasters, generalized issues associated with most natural disasters, and evidence-based principles and practices for supporting youth following a natural disaster. La Greca highlighted three phases of recovery following natural disasters and offers evidence-based interventions associated with each phase. These include the postimpact phase, short-term recovery and reconstruction phase, and the long-term recovery phase. The chapter outlines the effects of natural disasters on children and provides an overview of strategies for supporting children and adolescents following traumatic events. Posttraumatic stress disorder (PTSD) is characterized as an anxiety reaction that emerges after witnessing or experiencing a traumatic event. The chapter summarizes three evidence-based approaches to support children in the aftermath of a potentially traumatic event, such as a natural disaster: trauma-focused cognitive-behavioral therapy (TF-CBT), mindfulness-based stress reduction (MBSR), and the Mourning Child Grief Support Curriculum (MCGC).
This chapter examines the environmental factors that can contribute to the experience of medical trauma by increasing patients’ distress, impairing their sleep, and by becoming part of the trauma picture encoded in patient memory. It explores the areas of the hospital most associated with medical trauma, the emergency department (ED) and intensive care unit (ICU) as well as the many factors that create the sensory experience of the hospital. The high percentage of patients experiencing intense psychological distress has prompted many researchers to explore what exactly about treatment in the ICU leads to posttraumatic stress disorder (PTSD). When patients experience a traumatic medical event such as a heart attack, stroke, or obstetrical trauma that requires a lengthy stay in the hospital, they are at risk of experiencing psychological distress that can lead to depression, anxiety, and even PTSD.
This chapter describes the need for a specific focus on counseling women and girls. It discusses the fundamental tenets of empowerment feminist therapy (EFT). Gender and gender differences are not inherently problematic; however, issues arise when they become markers for which individuals are esteemed or devalued. Violence against women is a serious public health issue in every country in the world. Violence against women and girls takes many forms, some of which are accepted cultural practices that have severe negative repercussions for females’ physical and psychological well-being. Child marriage and female genital mutilation are two of these cultural practices. Due in part to trauma, oppression, and gender-role expectations, women and adolescent girls experience the highest rates of anxiety, depression, and posttraumatic stress disorder (PTSD). Out of the feminist movement, and in response to the biases inherent in mental health treatment, feminist therapy came into existence.
This chapter describes the assessment phase of the standard eye movement desensitization and reprocessing (
EMDR) protocol for treating posttraumatic stress disorder (PTSD). The two main purposes of the Assessment Phase are to access key aspects of the maladaptive memory network and to establish baseline measures for the level of disturbance in the target, rated with the subjective units of disturbance (SUD) scale, and the felt confidence in a positive self-appraisal, rated with the Validity of Cognition ( VoC) scale. In the Assessment Phase, one identifies the image or other sensory memory, negative cognition (NC), positive cognition (PC), specific emotion, and body location of the felt disturbance. The focus of the therapeutic work in EMDR reprocessing sessions is on the reorganization of the memory network. The last step in the standard assessment phase of the selected target is identifying the location of physical sensations associated with the maladaptive memory network.
This chapter examines additional issues to be considered when applying eye movement desensitization and reprocessing (
EMDR) to the treatment of individuals with specific phobias. It considers the nature of specific phobias, both those of traumatic and nontraumatic origins. It also examines the similarities and differences of specific phobias of a traumatic origin with posttraumatic stress disorder (PTSD). The chapter discusses the limited controlled research on all treatments for specific phobias of a traumatic origin. It reviews the literature on case reports of EMDR treatment for specific phobias and describes all eight phases of the standard protocol for EMDR treatment of specific phobias including how to identify targets, how to prepare patients, and the sequence of treatment for applying EMDR reprocessing. The chapter reviews a series of case vignettes that illustrate key aspects of applying EMDR therapy to the treatment of specific phobias.
- Go to chapter: An Overview of the Standard Eight-Phase Model of EMDR Therapy and the Three-Pronged Protocol
This chapter provides an overview of the standard eight-phase model of eye movement desensitization and reprocessing (
EMDR) therapy and the general three-pronged protocol that provides the framework for the specific treatment protocols for diagnostic groups. It briefly touches on clinical situations where the general principle of treatment planning based on the three-pronged protocol must give way to an initially inverted protocol for treatment planning that starts with reprocessing targets in the future, then on the present, and addresses past targets only after significant treatment gains have been achieved. The chapter explores the theoretical and practical aspects of the EMDR therapy approach to case formulation, treatment planning, and selecting and preparing patients with posttraumatic stress disorder (PTSD) and other post-traumatic syndromes for EMDR reprocessing. Screening for a possible dissociative disorder is essential before offering EMDR reprocessing on either traumatic targets or resource installation.
Children heal through play; it is their work. With posttraumatic stress, however, a child can be so shutdown and isolated within himself or herself that even the safe, welcoming environment of the play therapy room is not enough to unlock her chains. Such an environment creates a fear of self-expression. These behaviors and feelings have been documented by many who have researched posttraumatic stress disorder (PTSD) in children. The something more that is needed is Eye Movement Desensitization and Reprocessing (EMDR) therapy. EMDR therapy includes the Adaptive Information Processing (AIP) model, memories, neurological processes, and a distinct eight-phase integrative treatment approach using bilateral stimulation (BLS). Dysfunctional stored memories of events contain emotions, physical sensations, and beliefs that can become intrusive and result in hyperarousal and avoidant behaviors. EMDR therapy facilitates reprocessing the implicit to become explicit and useful. The therapy uses integration of mind, heart, and body at its core.
A Guide to the Standard EMDR Therapy Protocols for Clinicians, Supervisors, and Consultants, 2nd Edition
The book describes updated information on mechanisms of action of eye movement desensitization and reprocessing (
EMDR) therapy. It delivers clear, concise treatment guidelines for students, practicing clinicians, supervisors, clinic directors, and hospital administrators involved in the treatment of those with posttraumatic stress disorder (PTSD), Specific Phobias, and Panic Disorder. In EMDR therapy, various strategies can be employed to support the goals of stabilization and symptom reduction. Some stabilization strategies commonly used in EMDR therapy were developed in other traditions such as progressive relaxation, self-hypnosis, biofeedback, and meditation. The book provides an overview of the standard eight-phase model of EMDR therapy and the general three-pronged protocol that provides the framework for the specific treatment protocols for diagnostic groups. It briefly touches on clinical situations where the general principle of treatment planning based on the three-pronged protocol must give way to an initially inverted protocol for treatment planning that starts with reprocessing targets in the future, then on the present, and addresses past targets only after significant treatment gains have been achieved. The book explores the theoretical and practical aspects of the EMDR therapy approach to case formulation, treatment planning, and selecting and preparing patients with PTSD and other post-traumatic syndromes for EMDR reprocessing. Screening for a possible dissociative disorder is essential before offering EMDR reprocessing on either traumatic targets or resource installation. Case studies with transcripts illustrate the different protocols and further guide practitioners of EMDR therapy in informed decision-making.
This chapter describes the Reevaluation Phase and completing the treatment plan of the standard eye movement desensitization and reprocessing (
EMDR) protocol for treating posttraumatic stress disorder (PTSD). Reevaluation begins during the History Taking and Preparation Phase in which we consider the impact of patients’ disclosure of information, perceptions of the clinician’s responses, as well as the impact of skill building and stabilization exercises on patients’ stability, symptoms, and functioning. Monitoring patient responses to treatment is essential to the macro level of reevaluation. In other cases, mild regressions in functioning, especially after a session in which a traumatic memory was incompletely reprocessed, can be quickly overcome by resuming reprocessing to fully resolve the memory. Just as recurrent nightmares are symptoms of PTSD, so changes in these dreams after EMDR reprocessing of the memories are sometimes signs of shifts in the way information about traumatic experiences has been modified.
This chapter describes the procedures used in the desensitization phase- phase 4 of the standard Eye movement desensitization and reprocessing (
EMDR) protocol for treating posttraumatic stress disorder (PTSD). Standard EMDR reprocessing begins with the desensitization phase. The goal of the desensitization phase is to foster spontaneous emotional information processing that leads to synthesis between the maladaptive memory network of the selected target memory and other adaptive memory networks. During reprocessing, rapport is maintained by the pacing of the sets of BLS and the periodic brief pauses for patient reports than by the verbal interaction between clinician and patient. Before starting reprocessing, one should reinforce the patient’s orientation to dual attention. With effective reprocessing, patients can make reports that remain focused primarily on shifts within the selected target. In the desensitization phase, the purpose of returning to target is to determine if there is more material that needs to be reprocessed.
This chapter describes the Installation, Body Scan, and Closure Phases-Phases 5, 6, and 7-of the standard eye movement desensitization and reprocessing (
EMDR) protocol for treating posttraumatic stress disorder (PTSD). The aim of the Installation Phase is to extend reprocessing and ensure generalization of treatment effects with a complete integration of a new perspective on the target memory network. The first step in the Installation Phase is to check to see if there is a better, more appropriate positive cognition (PC). Tension in the neck and shoulders that emerged during the Installation Phase and was reported in the Body Scan Phase is likely to be linked to the targeted material. If this tension were not cleared in the Body Scan Phase, the session would be classified as incomplete. The Closure Phase serves several purposes. It provides a structured sense of completion to each EMDR reprocessing session.
This chapter presents the conceptual framework for understanding eye movement desensitization and reprocessing (
EMDR) therapy. It begins with a review of selected aspects of four models of psychotherapy that historically most directly support understanding the evolution of EMDR therapy. The early history and evolution of EMDR therapy in turn have been strongly associated with the search to understand and treat the relationship between trauma and dissociation. Classical behavior therapy views posttraumatic stress disorder (PTSD) through the lens of conditioning in which a powerful conditioned association is formed between specific cues were present at the time of adverse or traumatic experiences and the intense state of alarm evoked by the experience. In EMDR therapy, various strategies can be employed to support the goals of stabilization and symptom reduction. Some stabilization strategies commonly used in EMDR therapy were developed in other traditions such as progressive relaxation, self-hypnosis, biofeedback, and meditation.
This chapter discusses issues of power, the cycle of violence, learned helplessness (LH), the battered woman syndrome (BWS), and reasons victims stay in abusive relationships. Violence within intimate relationships can be understood as one partner gaining power over the other partner with the use of coercive and controlling tactics. Such tactics may be reinforced with physical and/or sexual violence. Battered women who acquire LH tend to be at high risk of developing posttraumatic stress disorder (PTSD) and major depressive disorder (MDD); their development of LH is associated not only with their abusive situation but also with past difficult life circumstances. The dynamics of domestic violence are so complex that it is difficult for most people to understand why a woman living in an abusive relationship does not simply leave. Many of the common explanations for why victims stay are myths.
- Go to chapter: The EMDR Approach Used as a Tool to Provide Psychological Help to Refugees and Asylum Seekers
This chapter describes the psychotherapeutic intervention for a particular clinical population: refugees and asylum seekers. These individuals live in a state of great vulnerability. For them, migrating was not a choice, but a decision forced by the particular conditions in their country of origin. The immigrant population is very heterogeneous due to different factors: their migration history and the reasons at the root of their migration; their social, cultural, and economic conditions; their status; and their ability to access national health care. One aspect that unites this population, however, is that they are particularly at risk for complex posttraumatic stress disorder (PTSD). Another key element of the treatment, especially in this type of population, and in general in those suffering from complex PTSD, is attention to the body. Eye movement desensitization and reprocessing (EMDR) targets memories felt in the body, promoting full access, reprocessing, and integration of the traumatic experiences.
The history of trauma-informed psychotherapy began differently from other psychotherapy theories as it was not based on just one person’s theory but rather was built up over the entire history of psychotherapy practice adding on piece by piece. One of the issues raised in feminist therapy was the confusion between victims of early trauma such as child abuse and later trauma reactions that looked like character changes seen in the diagnosis of borderline personality disorder (BPD). Trauma-informed services have a culture where all aspects of service delivery understand the prevalence of trauma, the impact of trauma, and the complex pathways to healing and recovery. Usually trauma-specific services address posttraumatic stress disorder (PTSD) and its subcategories as well as other consequences of trauma. Trauma-specific services also deal with the complexities of intersecting problems such as substance abuse, serious mental health problems, social problems, and client contact with the legal system.Source:
The Survivor Therapy Empowerment Program (STEP) is a carefully designed, evidence-based psychotherapeutic program that can be used to work with individuals or groups of abused women who have experienced intimate partner abuse or other forms of physical, sexual, and psychological abuse. STEP is based on a feminist and trauma-informed model where negative affect and anxiety are specifically addressed. There are six major goals for the STEP: safety, validation and support, cognitive clarity, emotional stability, healing from posttraumatic stress disorder (PTSD) symptoms and rebuilding resiliency and positive growth. The STEP is based on feminist and trauma theory and presents education about common issues for abuse victims that then can be discussed as they relate to the woman herself. She is then presented with learning new skills or reinforcing old skills that can help her make better choices in the future.Source:
This book examines new research regarding battered women and cross-cultural and cross-national issues, and addressed issues ranging from murder--suicide in domestic violence cases to proposed legislation and congressional resolutions. It reflects new research on traumatic responses, and addresses trauma-informed and trauma-specific psychotherapy, interventions with youth in juvenile detention centers, information from government task forces regarding children exposed to violence and juvenile justice, and new findings regarding the application of psychology to the legal system. Some of the battered women who already have been identified with a mental disorder that is exacerbated by the abuse or those who develop battered woman syndrome and posttraumatic stress disorder (PTSD) from the abuse itself may need some psychotherapy to help them heal and move on with their lives. The link between sex trafficking and domestic violence has also become much better known within the last 10 years. The concept of learned helplessness has been quite useful in expert witness testimony to help jurors understand how difficult it is for women to leave the relationship and why some women become so desperate that they must arm themselves against batterers. To eradicate domestic violence and violence in the community, people must stop modeling both sexist and violent behavior and change the divorce laws to empower children and abused women so they are no longer victimized by the abusers.
The consequences of deployment on the family can present an array of difficulties for the family due to lengthy separation periods. When counseling family members of veterans, an initial consideration should be taken into account at the onset of therapy. Particular concerns involve the reevaluation of family roles and expectations, parental involvement, restoring intimacy, and sharing a common understanding of the challenges faced during deployment. In conjunction with identifying whether the spouse or family member meets the diagnostic criteria for posttraumatic stress disorder (PTSD), assessing for domestic abuse is a necessary concern for mental health practitioners. Aside from the aforementioned treatment implications, family systems theory has been recommended when working with veterans and their families. The theory focuses on the past, present, and anticipated future, lending it to work well with families of veterans as it runs parallel with the phases of deployment.
This chapter serves as a brief introduction to psychiatric drugs. It addresses the more prevalent major drug classifications, including antipsychotic, antidepressant, antimanic, and antianxiety drugs. Subclasses are identified when appropriate, such as the selective serotonin reuptake inhibitor (SSRI) subclass of antidepressants. Some representative drugs for a specific subclass are also discussed; for example, the specific drug fluoxetine is addressed from the SSRI subclass. In addition, brand names are used in cases where a drug is commonly known by that name. A discussion of pharmacokinetics and pharmaco-dynamics is limited but is introduced in the review of antianxiety drugs to illustrate treatment strategies. Finally, a brief but meaningful review of the side effects of these medications is addressed. The goals of treatment of posttraumatic stress disorder (PTSD) are straightforward and include reducing primary symptoms, improving day-to-day functioning, treating comorbid symptoms, and preventing relapse.