Case Study 7th grade boy presents for treatment. Client has been referred due to oppositional behaviors, ditching school, fighting, and failing grades.

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