The intensive care survivor population is increasing. Critical illness can lead to long term psychological distress for a significant proportion of intensive care survivors. This situation has been brought into even starker focus with the impact of COVID-19. Critical illness can lead to long term psychological distress for a significant proportion of intensive care survivors. Risk factors for post-intensive care psychological distress include delirium experiences. This single case study describes the therapeutic process and utility of the Recent-Traumatic Episode Protocol (R-TEP), an eye movement Desensitization and reprocessing (EMDR) therapy protocol for early intervention, with an ICU survivor where therapy was conducted remotely. The treatment provision is unusual in terms of the use of the R-TEP protocol and therapy not being in person. Treatment response was assessed using three standardized measures pre-treatment, post-treatment and at 4-month follow-up, and through qualitative feedback. The advantages of the R-TEP structure are discussed and the need for further research with the ICU survivor population considered.
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- Go to article: The EMDR Recent Traumatic Episode Protocol With an Intensive Care Survivor: A Case Study
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 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 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).
- Go to chapter: Neurodevelopmental Approaches to Understanding and Working With Adolescents in the Juvenile Justice System
Neurodevelopmental Approaches to Understanding and Working With Adolescents in the Juvenile Justice System
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 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.
- Go to chapter: Use of Meditative Dialogue to Cultivate Compassion and Empathy With Survivors of Complex Childhood Trauma
Use of Meditative Dialogue to Cultivate Compassion and Empathy With Survivors of Complex Childhood Trauma
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.Source:
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.Source:
- Go to chapter: Substance Use and Co-Occurring Psychiatric Disorders Treatment: Systems and Issues for Those in Jail, Prison, and on Parole
Substance Use and Co-Occurring Psychiatric Disorders Treatment: Systems and Issues for Those in Jail, Prison, and on Parole
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.
- Go to chapter: EMDR Integrative Group Treatment Protocol© Adapted for Adolescents (14–17 Years) and Adults Living With Ongoing Traumatic Stress
EMDR Integrative Group Treatment Protocol© Adapted for Adolescents (14–17 Years) and Adults Living With Ongoing Traumatic Stress
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.