PTSD in Partners: A Treatment Approach with Eye Movement

Copyright 2014 Recovery That LastsCopyright 2014 Recovery That Lasts

PTSD in Partners: A Treatment Approach with Eye Movements(Accelerated Resolution Therapy)

Dallas, May 1,2,3, 2014Presented by Alexis Polles, MD, PLLC

[email protected]

m601-255-5485

Copyright 2014 Recovery That Lasts

DisclosuresNone

No relevant financial issues

If medications are mentioned the generic name will be used and non-FDA approved uses will be stated


OUTLINEI. Trauma and its sequelae

II. Trauma in partners of sexual compulsives/addicts (focus on women)

III. Treatment options

IV. Use of special approaches in the treatment of trauma Eye Movements

V. Conclusion



Definition of TraumaThe diagnostic manual used by mental health providers

(DSM-5) defines trauma an event that involves actual or threatened death or serious injury or sexual violation.

The Merriam-Webster Dictionary defines it as

a)an injury to living tissue caused by an extrinsic agent

b)a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury or

c)an emotional upset DSM-IV requirement that “The person’s response to the event must involve intense fear,

helplessness or horror” has been eliminated in DSM-5.


Trauma• May include events that are not beyond the scope of normal

human experience, as long as the event has had a trauma-like impact on the person.

• DSM-5 moved it from an Anxiety Disorder to Trauma- and Stress-or-Related Disorders

• What makes an event traumatic:– The severity of the event– The proximity of the experience– The personal impact of the event– The after-event impact


Potential Victims Of A Traumatic Stressor

1 Primary Victims

Those individuals most directly affected by the event, e.g., the persons whose houses are blown down in a hurricane.

2 Secondary Victims

Those individuals who in some way observe the consequences of the traumatic event on the primary victims, e.g., bystanders, rescuers, and emergency response personnel. (Partners/kids)

3 Tertiary Victims

Those individuals who are indirectly affected by the traumatic event as a result of later exposure to the scene of the trauma or to the primary or secondary victims of the trauma.

Stress Management and Disasters


Trauma Spectrum


Types of PTS/PTSD

Simple PTS/D

The response to one or more traumatic events that are NOT linked in any way (e.g., one rape, one car accident, one sudden loss).

Complex PTS/D

The response to a combination of specific traumatic events that ARE linked to each other in some way or occur repeatedly over time


Natural vs. Human Made Prolonged stressors, deliberately inflicted by people, are far

harder to bear than accidents or natural disasters. If this was done deliberately, in the context of an ongoing relationship, the problems are increased. The worst situation is when the injury is caused deliberately in a relationship with a person on whom the victim is dependent –

most extreme is parent-child; spouse or partner infidelities/betrayals are high on the list


Symptom Clusters(Four in DSM-5)

• Re-experiencing (nightmares, intrusive images)

• Avoidance

• Persistent Negative Alterations in Cognitions and Mood (includes numbing, distorted self-blame, estrangement, inability to remember key aspects of the event)

• Arousal (includes fight and flight)

Subtypes include kids < 6 and dissociative



Trauma is an experience that overwhelms our capacity to have a sense of control over ourselves and our immediate environment, to maintain connection with others and to make meaning of our experience.

In Summary:


Effects of Trauma on Brain Function

AmygdalaSorts for immediate

danger

(significance)

Pre-frontal Cortex(Integration and Planning)

Hippocampus Stores longterm memory

(cognitive map)


Fear Response

Copyright 2014 Recovery That Lasts16

Trauma Response

Visual Cortex

Amygdala



Hypothalamus-Anterior Pituitary-Adrenal Cortex Axis

Cortisol (stress hormone) elevates blood sugar and increases metabolism

Body is then able to sustain prolonged activity

But immune system activity is decreased

High cortisol levels damage hippocampus Learning and memory suffer

as a result


Tend and Befriend(Taylor, Lewis, Gruenwald, Gurung, Klein, & Updegraff, 2000; 2002)

Women developed other stress responses

To protect the child

To galvanize resources

Mediated by oxytocin


Partner Trauma Is

Modified from APSATS Multidimensional Trauma Model Training


Therapeutic OptionsPsychosocial

PharmacologicalComplementary


Healing is PossibleEvidence Supported Treatments

Narrative (oral, written, past tense, imaginal) Cognitive Therapy, Cognitive Processing Therapy (TfCPT) Exposure Therapy Stress Inoculation Training (SIT) Psychoeducation Eye Movement Desensitization and Reprocessing DBT Strategies Mindfulness Based Strategies Complementary and Integrative Modalities (Yoga, Meditation, Acupuncture) Pharmacotherapy (alpha 2 ligands, SSRI, SNRI) Avoid Ambien for sleep.

Consider B-blockers, and morphine in field or acute injury.



How It Works

Access relevant memoryStimulate brain with bilateral

stimulationMove through channels of association

until memory successfully resolved in EMDR or Image Replacement with ART


Courtesy Dr. Uri Bergman


NEURAL NETWORKS

Courtesy Dr. Uri Bergman


Yes, this is part of healing!


The ConclusionThe trauma reactions of partners of

sexual addicts who have been terrorized and repetitively assaulted are not due to the person’s “underlying issues,” they are the issue.


Core Principles of Partner TraumaAlmost all the behaviors are coping strategies.

Reactions are not character flaws.

Reactions are affected by supports and circumstances.

Behaviors may be effective or ineffective.

Responses will change if safety is established, though all triggers may not be eliminated.

There can be reconnection that is healthier and more deeply satisfying with God, ones self, and others, including the perpetrator.


Alexis Polles, MD, [email protected]

www.RecoveryThatLasts.com

PTSD in Partners: A Treatment Approach with Eye Movement

Health & Medicine

trauma spectrum trauma

partner trauma

effects of trauma

definition of trauma

event traumatic

event impact

event arousal

primary victims