Case Study 7th grade boy presents for treatment. Client has been referred due to oppositional behaviors, ditching school, fighting, and failing grades.
Case Study
Feb 03, 2016
Case Study. 7th grade boy presents for treatment. Client has been referred due to oppositional behaviors, ditching school, fighting, and failing grades. Post Traumatic Stress Disorder. LaMarr D. Edgerson MA, LMFT, CHt Trauma Specialist. Post Traumatic Stress Disorder. Anatomy. Memory. - PowerPoint PPT Presentation
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Case StudyCase Study
7th grade boy presents for treatment. Client has been referred due to oppositional behaviors, ditching school, fighting, and failing grades.
7th grade boy presents for treatment. Client has been referred due to oppositional behaviors, ditching school, fighting, and failing grades.
Post Traumatic Stress DisorderPost Traumatic Stress Disorder
LaMarr D. Edgerson MA, LMFT, CHtTrauma Specialist
Post Traumatic Stress Disorder
Post Traumatic Stress Disorder
Anatomy Memory
Trauma
Potentially Traumatic Events
Potentially Traumatic Events
War Terrorism Physical Assault Sexual Assault Being teased? Embarrassing
Moments
War Terrorism Physical Assault Sexual Assault Being teased? Embarrassing
Moments
Natural Disaster Death of loved one Domestic Violence Child Abuse Witness of events Emotional Abuse
Natural Disaster Death of loved one Domestic Violence Child Abuse Witness of events Emotional Abuse
PTSD StatsPTSD Stats
Est 5.2 million Americans dx between 18-54yrs old (3.6%).
1 million Vietnam Vets affected. What about Iraq and Afghanistan ?
Est 5.2 million Americans dx between 18-54yrs old (3.6%).
1 million Vietnam Vets affected. What about Iraq and Afghanistan ?
2x number of women affected vs men.
Often co-exist with depression, alcohol or other substance, or other anxiety disorders.
2x number of women affected vs men.
Often co-exist with depression, alcohol or other substance, or other anxiety disorders.
MaslowMaslowIn what ways can a traumatic event(s) effect your life?
Basic AnatomyBasic Anatomy
Our brain develops from back to front: primitive - executive functions arise in that order.
Our brain develops from back to front: primitive - executive functions arise in that order.
Lymbic SystemLymbic System The oldest part of the brain: This system is most
responsible for our flight or fight system.
It includes structures involved in emotion, motivation and emotional association with memory.
The oldest part of the brain: This system is most responsible for our flight or fight system.
It includes structures involved in emotion, motivation and emotional association with memory.
Hypothalamus Hippocampus Amygdala
Corpus CallosumCorpus
CallosumEach hemisphere of the human brain is a conscious system in its own right, perceiving, thinking, remembering,reasoning, willing and emoting. If the two hemispheres are separated, each is able to produce its own consciousness.
Each hemisphere of the human brain is a conscious system in its own right, perceiving, thinking, remembering,reasoning, willing and emoting. If the two hemispheres are separated, each is able to produce its own consciousness.
Split brain syndrome
Alien-hand syndromeThe left hand doesn’t know what the right hand is doing - literally
ThalamusThalamus
Major relay station that monitors and processes incoming info before it’s sent to the upper regions of the brain.
Receives auditory, somatosensory and visual sensory signals
Major relay station that monitors and processes incoming info before it’s sent to the upper regions of the brain.
Receives auditory, somatosensory and visual sensory signals
Not a part of the limbic system
HypothalamusHypothalamus
Regulates the autonomic nervous system via
hormone production and release. Initiates feelings, actions and emotions such as hunger, thirst, rage & terror. Affects and regulates blood pressure, sexual arousal and the sleep/wake cycle.
Regulates the autonomic nervous system via
hormone production and release. Initiates feelings, actions and emotions such as hunger, thirst, rage & terror. Affects and regulates blood pressure, sexual arousal and the sleep/wake cycle.
HippocampusHippocampus
Involved with recognizing new experiences and with learning and memory, especially short-term memory and information relating to recent events.
Involved with recognizing new experiences and with learning and memory, especially short-term memory and information relating to recent events.
AmygdalaAmygdala
Stores emotional parts of memory, especially powerful feelings; also concerned with emotions such as anger and jealousy, and drives such as hunger, thirst and sexual desire.
Stores emotional parts of memory, especially powerful feelings; also concerned with emotions such as anger and jealousy, and drives such as hunger, thirst and sexual desire.
Sends msg to hypothalamus for activation of sympathetic nervous system: increase reflexes, facial expression of fear,activate dopamine, epinephrine and norepinephrine.
Importance of the fear center
Importance of the fear center
Fight or Flight
MemoryMemory
What were you doing when this incident occurred?
MemoryMemoryInput From Senses
Sensory Memory
Long-Term Memory
Memory Consolidated
Short-Term Memory
Attention Paid
Attention Not Paid
Information Lost
Memories Not Consolidated
Short Term MemoryShort Term Memory
Also known as working memory Used to manipulate info (mental mapping for
directions)
Used to store small amounts for short periods (30-45 sec)
Quickly disappears by default - unless needed
Also known as working memory Used to manipulate info (mental mapping for
directions)
Used to store small amounts for short periods (30-45 sec)
Quickly disappears by default - unless needed
Memory trace
Long Term MemoryLong Term Memory
Structure: Hippocampus Anything from one minute - lifetime Needs to be encoded (associated in a
meaningful way) Associated in a meaningful way Consolidated and stored (permanent neuron
change) Believed to occur during dreaming (REM sleep)
Structure: Hippocampus Anything from one minute - lifetime Needs to be encoded (associated in a
meaningful way) Associated in a meaningful way Consolidated and stored (permanent neuron
change) Believed to occur during dreaming (REM sleep)
Hebb’s AxiomHebb’s Axiom
From the beginning of life, the brain responds to experience with the establishment of connections among neurons. Those pathways activated simultaneously become associated with one another and are more likely to be activated together again in the future.
From the beginning of life, the brain responds to experience with the establishment of connections among neurons. Those pathways activated simultaneously become associated with one another and are more likely to be activated together again in the future.
DreamingDreaming
Why do we dream?
DreamingDreaming
REM sleep is crucial for memory consolidationand has been suggested to facilitate long-term potentiationallowing the strengthening of synaptic connections.
Daniel Siegel
TraumaTrauma
Children & TraumaChildren & Trauma
Cognitive: shorter attention span, confusion regarding event, location sequencing.
Physical: loss of appetite, overeating, bowel/bladder problems, sleep disturbance.
Emotional: generalized fear, nervousness, anxiety, irritability, fearful of reminders.
Behavioral: bed wetting, thumb sucking, nightmares, repetitive play, anxious attachment, clinging, aggression, disobedience.
Cognitive: shorter attention span, confusion regarding event, location sequencing.
Physical: loss of appetite, overeating, bowel/bladder problems, sleep disturbance.
Emotional: generalized fear, nervousness, anxiety, irritability, fearful of reminders.
Behavioral: bed wetting, thumb sucking, nightmares, repetitive play, anxious attachment, clinging, aggression, disobedience.
Pre-School
Children & TraumaChildren & Trauma
Preoccupation with their own actions during the event, specific fears, retelling and replaying the event, impaired concentration and learning, sleep disturbance, concerns about safety(theirs & others), inconsistent bx, somatic complaints, confusion, fearful, concerns for other victims and their family, close monitoring of parent response & recovery.
Preoccupation with their own actions during the event, specific fears, retelling and replaying the event, impaired concentration and learning, sleep disturbance, concerns about safety(theirs & others), inconsistent bx, somatic complaints, confusion, fearful, concerns for other victims and their family, close monitoring of parent response & recovery.
3rd - 5th Grade
Children & TraumaChildren & Trauma
Detachment, shame, guilt, self consciousness about their fear, vulnerability & other emotional responses, acting out, need for revenge, radical change in world views, life threatening reenactment
Detachment, shame, guilt, self consciousness about their fear, vulnerability & other emotional responses, acting out, need for revenge, radical change in world views, life threatening reenactment
Adolescents
Children & TraumaChildren & Trauma
Can a traumatic childhood result in learning disabilities?
Can a traumatic childhood result in learning disabilities?
Thoughts
Studies in Beirut confirm that traumatized adolescentswith PTSD, as compared to non-traumatized adolescentlagged behind in academic achievement.
Lasting Effects Lasting Effects
Trauma doesn’t just affect the person who was exposed. It also affects all the people with whom that person interacts.
The more dependent a person is on a trauma survivor, the more deeply he or she
will be affected.
Trauma doesn’t just affect the person who was exposed. It also affects all the people with whom that person interacts.
The more dependent a person is on a trauma survivor, the more deeply he or she
will be affected.
Post-traumatic Stress Disorder
Post-traumatic Stress Disorder
Post-traumatic Stress Disorder
Post-traumatic Stress Disorder
Re-experiencing distressing images, unwanted memories, nightmares or flashbacks & physical symptoms.
Avoidance of reminders of the event, including people, places or things.
Hyperarousal, reflected in physiological symptoms: insomnia, irritability, impaired concentration, hypervigilience and increased startle response.
Re-experiencing distressing images, unwanted memories, nightmares or flashbacks & physical symptoms.
Avoidance of reminders of the event, including people, places or things.
Hyperarousal, reflected in physiological symptoms: insomnia, irritability, impaired concentration, hypervigilience and increased startle response.
Defined
Post-traumatic Stress Disorder
Post-traumatic Stress Disorder
PET Scans reveal that Vets with PTSD show increased right amygdala activity when exposed to combat movies.
MRI studies show that both male combat vets and women survivors of childhood sexual abuse have shrunken hippocampal volumes.
PET Scans reveal that Vets with PTSD show increased right amygdala activity when exposed to combat movies.
MRI studies show that both male combat vets and women survivors of childhood sexual abuse have shrunken hippocampal volumes.
Evidenced-Based
TherapyTherapy
Cognitive Behavior Therapy
Cognitive Behavior Therapy
CBT helps the client first identify the traumatic memory - evaluate their validity, challenge defeating or destructive thoughts, then replace them with a healthy emotional state.
CBT helps the client first identify the traumatic memory - evaluate their validity, challenge defeating or destructive thoughts, then replace them with a healthy emotional state.
Cognitive Restructuring
Cognitive Behavior Therapy
Cognitive Behavior Therapy
Benefit: Allows integration of trauma memory into conscious memory; associated thoughts are altered to reflect current life space & memories can become manageable (to an extent).
Benefit: Allows integration of trauma memory into conscious memory; associated thoughts are altered to reflect current life space & memories can become manageable (to an extent).
Cognitive Restructuring
Victim to survivor thinking
Reframing
Stops dysfunctional thoughts
Mind/Body ConnectionMind/Body Connection
Trauma is experienced at a sensory level and stored as an implicit memory. Implicit memory (sensations of trauma) must be linked with explicit memory (facts or reality of incident)in order for the victim to be able to reorder the experience in a way that is manageable.
William Steele, PhD
Exposure TherapyExposure Therapy
Derived from the learning theory. Fear is maintained through operant
conditioning & the effort to avoid or escape these responses.Avoidance supports the fear
Derived from the learning theory. Fear is maintained through operant
conditioning & the effort to avoid or escape these responses.Avoidance supports the fear
Exposure TherapyExposure Therapy In order modify the trauma - the memory must be fully
reactivated.
The client’s ability to decrease fear or anxiety is dependent on the “controlled” reliving of that fear in a safe environment.
The client is helped to form a new narrative that places the traumatic memory in the past as opposed to the here and now.
In order modify the trauma - the memory must be fully reactivated.
The client’s ability to decrease fear or anxiety is dependent on the “controlled” reliving of that fear in a safe environment.
The client is helped to form a new narrative that places the traumatic memory in the past as opposed to the here and now.
Exposure TherapyExposure Therapy
Art Therapy Play Therapy Stress Inoculation Systematic
Desensitization Virtual Reality
Art Therapy Play Therapy Stress Inoculation Systematic
Desensitization Virtual Reality
EMDR Emotional
Focused Therapy Tapas
Acupressure Therapy
EMDR Emotional
Focused Therapy Tapas
Acupressure Therapy
Challenges with trauma work
Challenges with trauma work
Avoidance **Disassociation** Increased drug &
alcohol usage Secondary Gain Blocking Flooding
Avoidance **Disassociation** Increased drug &
alcohol usage Secondary Gain Blocking Flooding
Lessons I have learnedLessons I have learned
Patience Think outside the
box Consider client
factors Stressors Health Relationships Finances
Patience Think outside the
box Consider client
factors Stressors Health Relationships Finances
Only speak when necessary Cognitive interweave
Follow the client It’s the client’s therapy
Don’t push
Only speak when necessary Cognitive interweave
Follow the client It’s the client’s therapy
Don’t push
Action PlanAction Plan
AA: assess for risk (self harm)
LL: listen non-judgmentally GG: give reassurance and
info. EE: encourage professional
help EE: encourage self care
AA: assess for risk (self harm)
LL: listen non-judgmentally GG: give reassurance and
info. EE: encourage professional
help EE: encourage self care
Post Traumatic Stress DisorderPost Traumatic Stress Disorder
LaMarr D. Edgerson MA, LMFT, CHtTrauma Specialist
The End
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