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.

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.

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 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.

Meeting academic demands, getting along with roommates, dealing with new social pressures, questioning career choices, managing finances, and other new responsibilities of the college experience can give rise to unexpected and undesired stress and anxiety. While event-related stress does not cause anxiety disorders on its own, it can worsen symptoms of a preexisting anxiety disorder or trigger an anxiety disorder in someone who may be predisposed. The symptoms of anxiety disorders generally involve disturbances in mood, thinking, and behavior. This chapter assesses the different classifications of anxiety disorders. Types of anxiety disorder includes generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder, and specific phobias. The chapter evaluates effective treatment and intervention strategies for college student population. Among other psychotherapy approaches, cognitive-behavioral therapy (CBT), relaxation therapy (RT), and mindfulness-based stress reduction (MBSR) have received considerable empirical support in the treatment of anxiety disorders.

This chapter examines the experience of internalized oppression within the Asian American community. It provides an introduction to the theoretical and applied literature that addresses the critical issue of how to challenge the internalization of one’s oppression. The critical educational disparities continue to be mirrored in employment, occupational, and income disparities. Parallel to these educational and employment risks, Asian Americans have also been found to be at risk for health disparities. In terms of mental health, posttraumatic stress disorder and depression are common in Cambodian and Vietnamese American refugees. As a continuation of these colonial experiences, Asians who immigrated to the United States were also looked down upon, considered of lower status, and were thus discriminated against, exploited, and, at worst, violently attacked and murdered. Cultural racism occurs when the values, norms, and beliefs of a group encourage often leading to the oppression of racial groups deemed inferior.

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.