This chapter presents a combined creative-corrective approach to working with the bereaved by emphasizing on cognitive assessment as a tool for social workers. It determines how best to facilitate an adaptive grief process with individuals who experience traumatic loss or complicated grief. Cognitive therapies (CT) and cognitive behavior therapies (CBTs) were found suitable with individuals suffering from posttraumatic stress disorder (PTSD), anxiety, and chronic or traumatic grief. Grief as a process of reorganizing one’s life and searching for a meaning following a loss through death is a painful experience. The Adversity Beliefs Consequences (ABC) model is based on a cognitive theoretical model to be applied in treatment of bereaved individuals. Like other cognitive models, rational emotive behavior therapy (REBT) emphasizes the centrality of cognitive processes in understanding emotional disturbance, distinguishing between two sets of cognitions that people construct, rational and irrational ones and their related emotional and behavioral consequences that differ qualitatively.

Social workers have a long history of working with abused children and adolescents. This chapter focuses on the clinical treatment of the abused child or adolescent using a cognitive behavior approach (CBT). It familiarizes the reader with the treatment of children and adolescents who are experiencing impairment as a result of post-traumatic stress associated with their history of abuse. The chapter focuses on the treatment of children who have been victims of physical and/or sexual abuse. Child abuse is a widespread problem that impacts society on a variety of levels having long lasting effects on the child, the family, and the community. The use of CBT in clinical social work with abused children and adolescents offers an opportunity to utilize treatment that has been shown to be effective in reducing posttraumatic stress disorder (PTSD) symptoms.

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.

There is a range of immediate orienting and defense responses available when a threat is perceived, and a separate but overlapping system of vigilance when there is awareness of a potential threat. Vogt, Aston-Jones, and Vogt propose that the reduced anterior cingulate functioning repeatedly demonstrated in posttraumatic stress disorder (PTSD) during emotional tasks facilitates the firing of locus coeruleus (LC) neurons to create a state of hyperarousal. The noncognitive suppression of emotions in young trauma sufferers is based in the areas of the ventral prefrontal cortex (PFC), which has outputs to the defense response and threat evaluation regions of the amygdala, the periaqueductal gray (PAG), and the nucleus accumbens, among others. Deep brain stimulation can be used clinically without activation of a fearful freeze response, so ventral areas of the PAG are also involved in physiological states of relaxation, comfort, and soothing from pain.

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 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 explains maltreatment as any form of physical, sexual, or emotional abuse and/or neglect, is associated with many negative outcomes, especially poor mental health. By understanding the impact of maltreatment on the developing brain, social workers can identify some of the underlying mechanisms of the psychiatric problems common in this population, and provide more effective treatment. Externalizing disorders, such as attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder, are the most common diagnoses given to children in the child welfare system but internalizing disorders, such as anxiety, depression, and posttraumatic stress disorder (PTSD), are frequently diagnosed as well. Hypothalamic-pituitary-adrenal (HPA) axis is one of the major pathways through which the effects of stress can shape brain development. The chapter illustrates how social workers can incorporate findings from neurobiological research into their clinical practice with maltreated children through the use of a case study.

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 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 briefly reviews the extant literature on the social neuroscience of risk-taking, and the developmental pathways to antisocial behavior among youth, including sexually abusive youth in the juvenile justice system. It explores neurodevelopmental impact of victimization, as well as the relationship between traumatic experiences, posttraumatic stress disorder (PTSD), and dissociation and sexual and nonsexual offending. The chapter discusses neuroethical and policy issues concerning the applicability of neuroscience in making decisions about criminal intent and culpability, along with considerations for implementing a trauma-informed approach in social work practice. Many juvenile offenders are vulnerable to exploitation themselves and have experienced multiple types of victimization, including complex trauma, which concomitantly impacts brain development. One commonality among various types of youthful offenders, especially habitual offenders, is a history of life course trauma, victimization, and mental health issues, such as attention deficit hyperactivity disorder (ADHD).

This chapter offers a review of selective literature on complex childhood trauma. It explains a case study demonstrating the use of meditative dialogue, a collaborative practice through which client and therapist are able to work together to develop empathy and compassion toward self and others during psychotherapy sessions. Thompson and Waltz described an inverse relationship between exposure to trauma and subsequent posttraumatic stress disorder symptom severity, and self-compassion. Recent neuroscience research has begun examining the effects of meditation practices on specific areas of the brain through neuroimaging studies. Clinical trials on the use of meditative dialogue in psychotherapy with survivors of complex childhood trauma, looking at the brains of the clients, and using magnetic resonance imaging (MRI) to measure changes, would help to demonstrate its efficacy and move it into the realm of evidence-based practices.

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 explores how memories for such traumatic experiences differ from memories for more mundane experiences, and what role the memories play in the development and maintenance of posttraumatic stress disorder (PTSD). When the memory refuses to fade and continues to intrude into daily experiences months or years later, PTSD may result. Those who have PTSD suffer through flashbacks, in which the memory for the event occurs without intention and feels like a reliving of the experience, and recurrent nightmares about the traumatic experience. Most people are convinced by their own experience that dramatic and traumatic events are better remembered than mundane or neutral ones. In fact, there is extensive evidence supporting this phenomenon of emotional enhancement of memory. People remember words on a list referring to emotional concepts better than neutral words and emotion-laden pictures better than neutral ones.

This chapter provides an overview of the neurophysiology underlying the innate human response of anxiety. Knowledge regarding the brain’s response to normal levels of stress and how it responds in a healthy manner will help clarify the various ways the brain can misfire and produce debilitating symptoms and outcomes. Posttraumatic stress disorder (PTSD) is an unhealthy emotional reaction to the experienced trauma. Inability to control stress can lead to release of neurochemicals and alterations in the hypothalamic-pituitary-adrenal (HPA) axis, which can result in both central nervous system (CNS) and parasympathetic nervous system (pNs) dysregulation. The mental health provider should be familiar with various anxiety disorders, so to diagnose more accurately, because treatment differs depending upon the specific anxiety disorder diagnosis. Generalized anxiety disorder (GAD) is the most frequently diagnosed anxiety disorder in general clinics, but it is one of the least frequently diagnosed anxiety disorders in specialized anxiety clinics.

This chapter describes how mental health and substance use interact with criminal justice involvement. It examines the common assessment and intervention strategies for co morbid mental health and substance abuse in forensic population and settings. The chapter gives a brief review of how substance use disorders co-occur with psychiatric disorders. The chapter describes prevalence of co-occurring disorders such as anxiety/depression, bipolar disorders, psychotic disorders, personality disorders, and posttraumatic stress disorder in general. It then discusses prevalence of psychiatric disorders in the prison/jail systems. The chapter also describes medication-assisted therapies for opioid use disorders and, treatment and aftercare services. It explores two of the most common types of treatments for those in the CJS, cognitive behavioral therapy (CBT) and 12-Step groups. The chapter further reviews two CBT programs, aggression replacement training and strategies for self-improvement and change.

This chapter defines emerging disabilities; explores medical, psychosocial, and vocational implications of emerging disabilities that distinguish them from traditional disabilities; and provides demographic characteristics of individuals who are most vulnerable to acquiring emerging disabilities. It examines some social and environmental trends that have contributed to the development of emerging patterns and types of disabilities including advances in medicine and assistive technology, globalization, climate change, poverty, violence and trauma, the aging American populace, and disability legislation. Psychological and physical trauma from warfare, violent crime, intimate partner violence, and youth violence can result in permanent physical, cognitive, and psychiatric disabilities. Diagnostic uncertainties, misdiagnoses, and skepticism on the part of medical providers are frequently associated with emerging disabilities. Women also represent a population that is at an increased risk of acquiring emerging disabilities and chronic illnesses. Rehabilitation systems are still not fully prepared to address the multifaceted needs of individuals with emerging disabilities.

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.

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.

Posttraumatic stress disorder (PTSD) can severely diminish the quality of life of the patient. Clinicians who wish to utilize hypnosis to help treat patients presenting with PTSD should familiarize themselves with the symptomatology and utilize appropriate screening measures. A thorough history screening will provide clinicians with important information regarding the onset of the trauma. Utilizing this information, clinicians are better able to adapt their treatment as well as the use of hypnotic suggestions to best suit the needs of their patients. Research on hypnosis for PTSD adjunctively with other treatments has been promising. While additional investigation is needed to determine which hypnotic techniques offer greater potential for the resolution of PTSD symptomatology, more recent studies have demonstrated support in favor of using manualized abreactive ego state therapy (EST) as a rapid psychological intervention for the treatment of PTSD providing durable symptom relief.

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.

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.

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.

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.

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 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 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.

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 each level of trauma by highlighting unique characteristics of specific diagnoses, procedures, and medical events. Many studies of gynecological and obstetrical trauma include an examination of patient risk factors that may contribute to the experience of a procedure as traumatic. Depending on the nature of the accident, patients may experience permanent injuries, chronic pain, and disabilities that can affect their lives in many ways, including the development of posttraumatic stress disorder (PTSD) and depression. Traumatic brain injury (TBI) occurs when an external force to the head causes injury to the brain, including damage to cells, brain structures, bleeding, and clots that can cause coma, nerve death, and a staggering number of intellectual, behavioral, and social problems. Medical trauma in the primary care setting can manifest differently depending on patients’ risk factors, past and current physical and mental health diagnoses, and prior history of medical trauma.

Eye movement desensitization and reprocessing-integrative group treatment protocol (EMDR-IGTP) combines the Standard EMDR Protocols and Procedures, including the some phases, with a group therapy model and an art therapy format, and uses the Butterfly Hug as a form of self-administered bilateral stimulation. For Jarero and Uribe, acute trauma situations are related to a time frame, and to a posttrauma safety period. They hypothesized that the continuum of stressful events with similar emotions, somatic, sensory, and cognitive information does not give the state-dependent traumatic memory sufficient time to consolidate into an integrated whole. Short posttraumatic stress disorder (PTSD) Rating Interview (SPRINT) performs similarly to the Clinician-Administered PTSD Scale (CAPS) for the assessment of PTSD symptom clusters and total scores, and it can be used as a diagnostic instrument. Intensive administration of the EMDR-IGTP can be a valuable support for cancer patients with PTSD symptoms related to their diagnoses and treatment.

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 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.

This chapter covers a wide range of strategies for maintaining and restoring effective reprocessing in the desensitization phase-phase 4-of the standard eye movement desensitization and reprocessing (EMDR) protocol for treating posttraumatic stress disorder (PTSD). It begins with clarifying standard sequences and decision trees that guide clinical work. When reprocessing target memories that are strongly, emotionally charged, it is not unusual for patients to experience intense emotional responses during reprocessing. The chapter examines the issues and strategies for supporting patients experiencing prolonged, intense emotional responses. It explores when and how to use interventions to deliberately stimulate an adaptive memory network to encourage synthesis with the selected target memory, which Shapiro refers to as ’cognitive interweaves’. When one have developed and installed resources during the Preparation Phase of treatment, these resources can be re-accessed as interweaves during ineffective reprocessing to assist patients in locating adaptive memory networks.

This chapter lists and examines essential criteria to consider when assessing patient stability and readiness for the standard eye movement desensitization and reprocessing (EMDR) procedural steps. In considering a patient’s suitability and readiness for standard reprocessing, five kinds of issues need to be considered: medical concerns; social and economic stability; behavioral stability; mood stability; and complex personality and dissociative disorders, life-threatening substance abuse, and severe mental illness. Depersonalization and derealization as expressions of primary structural dissociation are frequently the only dissociative symptoms in patients with posttraumatic stress disorder (PTSD). The chapter reviews standardized assessment tools that can assist clinicians in assessing symptom severity, screening for dissociative disorders, and monitoring treatment progress and outcomes. The trauma assessment packet includes four test instruments, along with three research and clinical articles, which together provide a comprehensive assessment of trauma histories at different ages.

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.

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 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.

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.

When panic disorder is accompanied by severe avoidance of places or situations from which escape might be difficult or embarrassing, it is specified as “panic disorder with agoraphobia”. Despite the well-examined effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in the treatment of posttraumatic stress disorder (PTSD), the applicability of EMDR therapy for other anxiety disorders, like panic disorders with or without agoraphobia (PDA or Pathological Demand Avoidance), has hardly been examined. This chapter illustrates how EMDR therapy can be applied in the treatment of panic disorder with or without agoraphobia. The EMDR protocol for panic disorders with or without agoraphobia is scripted. To determine whether a client suffers from panic disorder with or without agoraphobia, and its severity, a standardized clinical interview, such as the Structured Clinical Interview for DSM-IV Axis I disorders should be administered.

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 possible interactions between trauma and psychosis and offers several methods for conceptualizing a case to facilitate the application of eye movement desensitization and reprocessing (EMDR) in the treatment of people with psychosis. A psychotic disorder is often accompanied by at least one comorbid disorder, such as posttraumatic stress disorder (PTSD), depressive disorder, social phobia, substance abuse and dependence, or obsessive-compulsive disorder. A comprehensive treatment program offered by a multidisciplinary team is recommended. This includes pharmacotherapy, case management, cognitive behavioral therapy (CBT), supported employment, family interventions, and peer support. Standardized treatment protocols are feasible without adaptations and are effective in treating comorbid PTSD. Both antipsychotic medications and medication preventing motor side effects of anti-psychotics can affect cholinergic receptors. It can be difficult to judge the distress that a patient experiences during EMDR, due to some of the negative symptoms of schizophrenia.

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.

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.

This chapter examines how to prepare patients for the reprocessing phases of the standard eye movement desensitization and reprocessing (EMDR) therapy procedure. The essential elements of the preparation phase covered in the chapter include providing patients the fundamental information needed for informed consent, and offering guidance and metaphors to orient patients to standard EMDR reprocessing procedures. The Preparation Phase in the EMDR approach to psychotherapy corresponds with the initial stabilization or ego-strengthening phase of treatment in the consensus model of treatment for trauma. An essential aspect of the preparation phase is patient education. Patients need to understand their diagnosis, symptoms, the impact of adverse and traumatic experiences, the stages of the treatment plan and what to expect during EMDR reprocessing. For those with histories of exposure to traumatic life experiences, normalizing the development of posttraumatic stress disorder (PTSD) is essential.

This chapter provides an excellent and comprehensive resource for helping professional counselors understand the difficult challenges that military personnel must navigate during various stages of their deployment cycle. Mental health counselors are challenged with providing disaster and trauma counseling services to a variety of populations, some of whom may be culturally different. Mobilizations can occur in the continental United States or overseas, typically referred to as ‘deployment’. Some military personnel are mobilized or deployed for humanitarian missions while others are in support of combat troops. Mental health professionals who do not understand the unique aspects and challenges of service members within the deployment cycle may not understand military culture. Military members that have comorbid conditions such as depression or bipolar disorder are at the highest risk, followed by those with substance use disorder (SUDs), posttraumatic stress disorder (PTSD), and traumatic brain injury (TBI).

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 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.

The Compassion Fatigue Awareness Project has self-tests available at no charge to help identify the state of one’s personal union at this moment and then to keep tabs on how it looks over time. There are three assessments namely Professional Quality of Life (ProQoL) Self-Test, The Compassion Fatigue Self-Test and The Life Stress Self-Test. Problems that can occur when caretakers are exposed to and/or witness traumatic events like primary, secondary traumatic stress and vicarious trauma (VT). Burnout and compassion fatigue can appear in many professions, but VT is specific to trauma workers and so symptoms will often mirror client symptoms and deliver very specific intrusive imagery, and other negative consequences stemming from the client’s trauma material. The attention that is paid to the other routine details of private life must be extended to the professional practice of self-care in order to avoid the pitfalls of developing compassion fatigue and VT.

This chapter explains how the ecological perspective (EP) of understanding human behavior can be applied to an understanding of medical trauma. Studies of the effects of medical trauma often focus on specific factors of the patient: Preexisting mental health problems, past history of trauma, and personality factors are but a few topics addressed in the literature about medical trauma. While some traumas occur outside of human relationships, medical trauma is often a relational trauma in that it occurs within the context of the patient-provider relationship. As a result of the silent suffering experienced by some patients, medical trauma can be thought of as a disenfranchised trauma. Most research on medical trauma has explored the effects of specific medical events and diagnoses on various psychological domains and on the development of posttraumatic stress disorder (PTSD), sometimes isolating certain risk factors and qualities of the patient.

This chapter presents the available evidence related to postpartum mood and anxiety disorders. It addresses the three postpartum mood disorders-postpartum psychosis, bipolar II disorder, and postpartum depression. Postpartum psychosis is a psychiatric emergency that requires immediate intervention and hospitalization. This dangerous mood disorder presents rapidly after birth. Symptoms can include rapid mood fluctuations, delusions, hallucinations, marked confusion, extreme agitation and disorganized speech. Postpartum depression not only negatively affects mothers’ quality of life but it extends to negative consequences for their children. Midwives have clearly identifiable predictors that allow clinicians to screen and monitor these high-risk women for early intervention and help to prevent the development of postpartum depression. There are three postpartum anxiety disorders that women can experience. These disorders include postpartum onset panic disorder, postpartum obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) following traumatic childbirth. Middle range theory of traumatic childbirth is valuable source for evidence-based practice.

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.

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).

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.

Eye movement desensitization and reprocessing (EMDR) therapy may be particularly useful for phobic conditions with high levels of anxiety, with a traumatic origin or with a clear beginning, and for which it is understandable that resolving the memories of the conditioning events would positively influence its severity. This chapter illustrates how EMDR therapy can be applied in the treatment of specific fears and phobic conditions. It discusses four cases where clients actually underwent the dental treatment they feared, most within 3 weeks following EMDR Therapy treatment. The efficacy of EMDR therapy was also tested in a randomized clinical trial among 30 dental clients who met the DSM-IV-TR criteria of dental phobia, and who had been avoiding the dentist for more than 4 years, on average. Clients in the EMDR Therapy condition showed significant reductions of dental anxiety and avoidance behavior as well as in symptoms of posttraumatic stress disorder (PTSD).

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 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.

This chapter presents a case study to illustrate the challenges faced by veterans in adjusting to civilian life. Due to differences between the military and civilian life, many veterans struggle with understanding others in a work environment and adapting to changing demands. In fact, most veterans who need mental health treatment never seek it out. Disability is not uncommon among this population. In fact, there are numerous disabilities among this population including both physical disabilities and psychiatric disabilities; posttraumatic stress disorder (PTSD) and traumatic brain injuries are among some of the more common disabilities. There continues to be a stigma regarding seeking out mental health services. In addition to relationship issues, Cornish found that veterans struggled with anxiety, anger, depression, and thoughts of suicide. The numerous challenges faced by veterans in adjusting to civilian life are impacted by a loss of identity and the loss of support.

This chapter focuses on the first four stages of the problem-solving model: engagement, assessment, planning/contracting, and implementation for working with victims of intimate partner violence (IPV). It presents theories, tools, and models for empowering victims including the use of safety plans, crisis counseling, and long-term intervention strategies. For clients who do display evidence of IPV, a full-scale IPV assessment is to be completed, which consists of three parts: history taking; determining the primary batterer and victim; and lethality assessment. Among common problems of IPV victims are those of posttraumatic stress disorder (PTSD), substance abuse, and sexually transmitted disease (STD). There is an intersection between IPV and HIV/AIDS. Women who have been sexually and physically abused by intimate partners are more than three times as likely to report having a STD. The more abuse a victim suffers, the higher the risk for STDs and HIV.

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.

One of the most widely known, researched, and disseminated therapeutic interventions for traumatized children and adolescents is trauma-focused cognitive behavioral therapy (TF-CBT). The TF-CBT model being implemented today began when several clinical researchers combined their similar trauma-focused interventions into a single model with the most efficacious components. The new model combined well-established cognitive behavioral, learning, and family therapy theory and techniques with emerging research on childhood posttraumatic stress disorder (PTSD), neuroscience, and child development. The result was a relatively short-term, manualized intervention that included both the child and the nonoffending caregiver in the treatment process and could be implemented in a wide variety of settings. TF-CBT contains specific goals for the child and the nonoffending caregiver. TF-CBT caregiver goals include helping nonoffending caregivers cope effectively with their own emotional distress while supporting their child’s recovery.

This chapter presents an overview of posttraumatic stress disorder (PTSD) in childhood and adolescence, including how symptoms may present and what factors are associated with risk of developing PTSD. It provides a review of the research literature and a step-by-step guide for practice for two empirically validated treatments for youth PTSD. The symptoms of PTSD are grouped into four clusters: intrusion symptoms, avoidance symptoms, cognition and mood symptoms, and arousal and reactivity symptoms. Trauma-focused cognitive behavioral therapy (TF-CBT) was initially developed to address trauma associated with child sexual abuse and has subsequently been adapted for use with children who have experienced other trauma types. Research indicates that TF-CBT is effective in treating PTSD, depression, and related behavioral problems in children exposed to traumatic events. The chapter provides a step-by-step breakdown of TF-CBT and Prolonged Exposure for Adolescents (PE-A) interventions, including descriptions of core components and standard implementation practices.

This chapter presents a case study of a 15-year old White female. It outlines the process of finding healing through charting memories utilizing an evidence-based treatment. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based treatment used to treat posttraumatic stress disorder (PTSD) experienced by children ages 3 to 18. As the name indicates, the theoretical base lies in the cognitive behavioral school of thought. The overall focus of TF-CBT is to build physical, emotional, and cognitive coping skills; bolster the parent-child relationship; gradually expose and desensitize; and create new meaning surrounding the trauma. Most importantly, it is used to help the child to not be defined by the trauma. Rather than proceeding chronologically or focusing on a specific traumatic event, exposure during the trauma narrative (TN) is focused on themes and difficult thoughts and feelings that arise out of the client’s trauma experiences.

This chapter provides information for school psychologists that focuses on child trauma and the ways in which children and adolescents respond to traumatic experiences. It addresses Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition; DSM-5) diagnostic issues related to Posttraumatic Stress Disorder (PTSD) and considers the use of a proposed diagnosis: developmental trauma disorder. Cultural issues related to traumatic events experienced by children of color, such as community violence, racial trauma, and PTSD symptomatology among underrepresented groups, are also addressed. The chapter informs school psychologists about the impact of trauma on social–emotional well-being, behavioral functioning, and learning among children. Implications for school psychologists and their role in implementing educational and social–emotional supports and mental health interventions are discussed.

The purpose of this chapter is to outline particular consequences of trauma when it occurs during adolescence, as well as what one might expect subsequent to earlier childhood traumatic events that occurred. This aim is accomplished in the following sections: (a) Trauma-Relevant Issues in Adolescence and (b) Counseling Implications. These major sections are followed by a summary of the chapter and an online list of relevant resources.

Sex therapy addresses sexual function, but goes beyond offering information and solutions to dig deeper into an understanding of why the sexual symptom occurred. Like other psychotherapists, sex therapists rely on a variety of theoretical approaches to organizing and treating presenting problems, for example, emotionally focused therapy, narrative therapy, cognitive-behavioral therapy, family therapy, and so on. This chapter discusses Murray Bowen’s Intergenerational Theory. Mental health professionals will be familiar with the symptoms and treatment of posttraumatic stress disorder (PTSD). Symptoms commonly associated with PTSD, such as flashbacks and nightmares, can interfere with sexual function. Sexual difficulties related to PTSD include the development of a sexual aversion, low desire and problems with arousal, anorgasmia, and painful intercourse. The chapter describes interventions such as deep diaphragmatic breathing, rapid eye movement desensitization, body-centered approaches, and cognitive therapy. Finally, the chapter discusses perinatal depression, its risk factors, and interventions.

The purpose of this chapter is to explicate the impact that war has on members of the military. In describing the effects of war on combat veterans and the challenges posed for those who return from war, potential needs for relevant mental health services are made explicit. The chapter identifies practice implications and offers an online list of resources for professionals working with military veterans.

This chapter introduces foundational knowledge necessary for understanding the effects of psychosocial trauma, stress, crisis, and disaster. It offers brief discussions about the historical implications of how psychosocial trauma has come to be defined as well as how the related diagnostic categories have developed. Finally, the importance of recognizing the human capacity for resilience and growth, in the face of trauma, is emphasized.

Moral injury is an evolving condition. It is not a mental health disorder; therefore, it does not have a diagnostic category. Neither is there a categorical cutoff score to determine if a person qualifies as having the condition. While moral injury can be a stand-alone injury, it is frequently assessed along with acute stress or posttraumatic stress disorder mental health diagnoses. The memory of the moral injury incident(s), like any other disturbing memory, can be treated with the standard Eye Movement Desensitization and Reprocessing (EMDR) protocol. This chapter prepares the EMDR therapist to understand the three levels of moral injury complexity, the self-referential emotions of shame and guilt, the use of cognitive interweaves, and the multidisciplinary approaches of moral philosophy, mental health, and moral theology/spirituality. It discusses the use of EMDR therapy in treating the complexities of moral injury with scripted examples.

This chapter focuses on the loss, grief, and trauma that survivors may experience in the aftermath of a homicide or suicide. The chapter examines the various effects of homicide and suicide and discusses treatment strategies for working with survivors.

Sexual violence is a significant social problem worldwide, occurring at alarmingly high rates and is associated with a host of negative outcomes including posttraumatic stress disorder (PTSD). The purpose of this chapter is to present an ecological model that enhances an understanding of survivor responses to sexual violence and informs treatment for sexual trauma. The chapter will examine the many systems that affect survivors’ recovery and will provide an overview of clinical guidelines for treating sexual trauma, including prolonged exposure (PE), trauma-informed CBT (TF-CBT), cognitive processing therapy (CPT), and Eye Movement Desensitization and Reprocessing (EMDR).

This chapter focuses on the intolerance experienced by marginalized groups of people, based on race, ethnicity, and immigration status. It reviews current knowledge about violence-based trauma among minority groups and offers discussions that highlight historical patterns of and risk factors for PTSD. The chapter briefly summarizes interventions and treatments that relate to race-based, ethnicity-based, historical, and intergenerational trauma.

The term “battered woman syndrome” (BWS) was first used as the title to the US National Institute of Mental Health (NIMH)-funded research grant that collected data on over 400 self-referred women who met the definition of a battered woman. Although the term BWS appeared prior to the addition of the diagnostic category “posttraumatic stress disorder” (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders, the theoretical basis upon which the BWS was developed was similar to what later became known as PTSD. This chapter discusses the analysis of how construct of BWS was validated from the various analyses of data collected over the past 40 years. A consistent theme in the battering incidents reported by the cross-national samples of women was the amount of jealousy in the relationships. Talking with other men or spending time with other people besides the batterer, resulted in an acute battering incident.

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.

This chapter focuses on the central role of disability in how people experience, deal with, and overcome traumatic experiences. Stress can emerge from a variety of health conditions (e.g., congenital disability, adventitious disability, chronic illness) and can be exacerbated significantly when one experiences trauma. Disability and trauma are not mutually exclusive experiences; in fact, they are not infrequently seen in tandem. Although trauma is frequently associated with large-scale natural events (e.g., hurricane, tornado, war), people with disabilities (PWD) experience various degrees of trauma due to pervasive societal discrimination, which can result in a number of psychopathologies necessitating affective type treatments. Despite trauma survivorship being common in nearly all societies around the globe, the evidence base has been thin, but the number of available interventions with promising options has been evolving quickly. The recovery from the effects of both disability and trauma is a process that requires an understanding of the diversity of factors that contribute to the trauma as well as the customization of treatments to individuals’ life situations.

Crisis intervention is one of the essential practice models used within a generalist-eclectic framework that prepares social work and counseling professionals to handle acute crises of various types and causes. Clients typically experience difficulties or obstacles in effectively resolving the impacts that result from an acute stressor, a pileup of stressors, or a traumatic event. Crisis intervention is a time-limited model that mobilizes needed support and resources, along with the client’s strengths and adaptive coping skills to address the precipitating event and aftermath. The goals of crisis intervention are to reduce or resolve the effects of the traumatic event or crisis so that clients can return to a pre-crisis level of functioning and, hopefully, decrease the development of posttraumatic stress disorder (PTSD). This chapter presents an overview of the historical development of crisis theory and intervention models. The basic assumptions and theoretical constructs of crisis theory are introduced, and connections to other direct practice theoretical models such as ego psychology, cognitive behavioral, and solution-focused models are explained. Descriptions of the levels and stages of crises are provided with discussion of several different practice models and basic intervention strategies. Case examples are also included that illustrate how crisis intervention can be applied across a wide variety of clients, settings, and types of crises and trauma.

Counselors and other therapists providing counseling to clients diagnosed with posttraumatic stress disorder (PTSD) may be at greater risk for developing secondary trauma, also called vicarious trauma. While PTSD had been the focus of much research in the counseling field, less emphasis has been placed on counselor self-care. This chapter focuses on the rationale for counselor self-care.

Military personnel and veterans are members of a unique and proud group within the overall culture of the United States. It is essential that counselors working with this population recognize high rates of alcohol use co-occur with traumatic brain injury as well as mental health issues such as posttraumatic stress, depression, and anxiety—especially among active-duty service members and veterans who were exposed to combat situations. With the withdrawal from Afghanistan, the deployment cycle of military unit rotations from the United States to overseas locations and back to stateside is slowing; however, the rotations that continue to occur places strain on individual service members and their families. Because military personnel and veterans are at risk of developing co-occurring mental and substance use disorders, counselors must be clinically astute and culturally aware when providing services to this population.

In this chapter, eye movement and desensitization and reprocessing (EMDR) is explained from its theoretical construct to its methodology in clinical practice using adaptive information processing as a basic tenet. Evidence exploring its efficacy and a step-by-step process of the eight-phased protocol used to help clients suffering from posttraumatic stress disorder, anxiety, substance use disorder, and many more common psychological issues are explained in detail. Three case examples help readers to understand how EMDR is used and its healing of trauma symptoms.

This chapter provides a basic understanding of the symptoms of traumatic brain injury (TBI), familiarization of measures used by the military and veteran agencies in evaluating the level of severity and the key questions to address. It discusses the overlap of symptoms among TBI and posttraumatic stress disorder (PTSD), and the effective application of eye movement desensitization and reprocessing (EMDR) therapy in the treatment of PTSD among persons with both PTSD and TBI diagnoses. Since many therapists treat clients with these dual diagnoses, a review of brain injury assessment is provided while considering EMDR therapy as a treatment modality. Understanding the assessment process informs the therapy on the severity of the brain injury. The chapter provides a review of PTSD measures for application in military, veteran, and private practice settings. It also provides a case example.

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.

Posttraumatic stress disorder (PTSD) is a condition that is characterized by profound neurochemical and neuroendocrine changes in the central nervous system (CNS). The physical response to trauma, in those susceptible to its development, can induce physical and behavioral changes. Understanding the impact of these neural changes is the basis for developing a rational medication therapy regimen for a client diagnosed with PTSD. The use of these medications is vital for symptom management so that the benefits of counseling can be realized. This chapter will discuss the neuronal and pathophysiological impact of trauma on the brain while subsequently describing how medications can impact symptom improvement. Medications that are discussed in this chapter include the use of antidepressants, antipsychotics, and other novel agents used in the pharmacotherapy of PTSD. Both U.S. Food and Drug Administration (FDA)-approved medications and “off-label” medications are explored.

The distress of populations affected by genocide, war, and the specific phenomenon often referred to as “ethnic cleansing” and political violence is typically viewed through the lens of trauma and posttraumatic stress disorder (PTSD) (the word “war” is used in the rest of this chapter to refer specifically to “ethnic cleansing”). However, there have been increasing critiques of the assumed universal applicability of the trauma paradigm, from psychologists and psychiatrists, as well as anthropologists and sociologists, engaged with individuals and societies affected by mass violence. This chapter reviews how the specific characteristics of genocide, war, and political violence pose challenges to biomedical and Western psychological framings of trauma. It argues the need for greater attention to cultural context, intersecting structural oppressions, and social justice and considers how narrative- and arts-based tools, underpinned by principles drawn from multicultural and decolonial approaches, may assist in this endeavor.

Women were less likely to be able to leave a domestic violence relationship if they had substance abuse problems. Linking alcohol abuse with batterers and battered women, then, is a natural association. The relationship between substance abuse and aggression and/or interpersonal violence is more complex because of the pharmacological and physiological interaction of the different substances. Several studies have associated cocaine, crack, amphetamine, and methamphetamine use with increased violence. Individuals who abuse psycho stimulants may be inherently aggressive, antisocial, or psychopathic sensation seekers. And women who abuse substances to self-medicate from the symptoms of posttraumatic stress disorder (PTSD) and battered woman syndrome (BWS) need specialized treatment for the abuse they have experienced in addition to treatment for alcohol and other drugs. Cognitive rehabilitation as well as trauma treatment and drug treatment are all needed, especially for those who have been abusing substances over a long period of time.

In 1980, the battered women advocates attempted to take control of what loosely was called “the battered woman’s movement” away from the professionals. However, some of those 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 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 history of society’s newest interest in the eradication of violence against women and children demonstrates both the intricacies of the problem and the difficulties in dealing with it. Although shelters do provide safety for only a small number of women and children, their presence in a community sends a message about zero tolerance for such abuse.

Many Hispanics/Latinos have a high need for mental health services. Their emotional needs include issues around ethnic identity, immigration, acculturation, and discrimination. It has been suggested that H/Ls’ risk of mental illnesses is closely associated with the duration of stay in the United States, suggesting an inverse relationship to acculturation. Research suggests that compared to Anglo Americans, Hispanics have less access to and availability of mental health services, are less likely to receive needed mental health services, often receive a poorer quality of mental health care, and are under-represented in mental health research. The treatment of H/L men by psychotherapy remains one of the most challenging of all endeavors for the psychologist or therapist. Counselors must be culturally sensitive when treating H/Ls, keeping in mind traditional family patterns and gender norms, as well as other stresses that influence or can present as a mental health concern.

Dissociative identity disorder (DID) is usually a reaction to trauma as a way to help a person avoid bad memories and is characterized by the presence of two or more distinct personality identities. This chapter highlights the detailed case of an adult woman diagnosed with DID. The case offers an in-depth description of the client’s identities and takes the reader on a journey through her treatment. Questions for consideration are also included.

This chapter addresses the complex relationship between child abuse and domestic violence. The Convention on the Rights of the Child (CRC) was developed by the United Nations over a 10-year period to protect the human rights of the child by banning discrimination against children and affirming special protection and rights appropriate to minors. Forensic mental health experts who specialize in child custody evaluations come more from the perspective of child protection and rarely understand how to support and reempower the mother who has been abused. Posttraumatic stress disorder (PTSD) is the most commonly diagnosed disorder in abused children, although some of the symptoms are not easily seen in young children who often show dysregulation of their body functions. Newer psychotherapy strategies called “trauma-specific treatment” may help children who have been abused heal from the trauma.

Multiple sclerosis (MS) is a chronic neurological disease of the central nervous system that affects both the brain and the spinal cord by destroying the myelin sheath that protects the nerve fibers. This chapter describes the eye movement desensitization and reprocessing (EMDR) therapy approach applied to the treatment of posttraumatic reactions related to MS. It briefs the emotional burden of MS and specific disease-related problems, followed by the main results of research in psychosocial treatments. The chapter explores the clinical features of traumatic reactions related to the disease. This protocol aims to support patients in their difficult tasks of coping with the following: the illness, fears connected to its future progression, and the difficult choices managing the stage of the disease characterized by the significant worsening of symptoms, often resulting in the total loss of autonomy and the ability to communicate normally with the external world.

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.

The US Centers for Disease Control and Prevention (CDC) has conducted studies about adverse health conditions and health risk behaviors in those who have experienced intimate partner violence (IPV). The high numbers of women who report childhood abuse and IPV and receive no assistance in healing from the psychological effects obviously will be seen in medical clinics, often too late to stop a disease process that might have been prevented had their posttraumatic stress disorder (PTSD) responses been dealt with earlier. One of the most negative and lasting effects of IPV on women appears to be the impact on the women’s body image, which is related to their self-esteem. Although the health care system has attempted to deal with battered women, in fact both the structure and function are not set up to be helpful, especially when chronic illnesses are exacerbated by environmental stressors such as living with domestic violence.

This chapter explores some of the most commonly seen non-evidence-based treatments (non-EBTs) in psychology and counseling, from treatments for specific disorders, such as autism spectrum disorder (ASD), posttraumatic stress disorder (PTSD), and substance abuse, to psychological assessment measures. ASD is characterized by impairments in social interaction and communication, frequently accompanied by repetitive self-soothing behavior. Four of the most widespread pseudoscientific treatments for trauma-related problems are critical incident stress management (CISM), eye movement desensitization and retraining (EMDR), emotional freedom technique (EFT), and thought field therapy (TFT). The Thematic Apperception Test (TAT) manuals provide very clear and detailed procedures, but similar to what happened with the Rorschach, numerous other systems and methods of using the TAT developed. Given the preponderance of non-EBT for psychological problems, one must often be careful in choosing a provider of mental health services, whether that person is a psychologist, psychiatrist, professional counselor, or other kind of therapist.