VIOLENCE AND PTSDVIOLENCE AND PTSD

Human Responses and Human Responses and HealingHealing

Brenda Wiewel, LCSWBrenda Wiewel, LCSW

““Your vision will become clear only when you can Your vision will become clear only when you can look into your own heart. Who looks outside, look into your own heart. Who looks outside, dreams. Who looks inside, awakes.”dreams. Who looks inside, awakes.”

Carl JungCarl Jung

SOURCES:SOURCES:

• Dayton, Tian, PhD., Dayton, Tian, PhD., 2000. 2000. Ending the Ending the Cycle of Trauma and Cycle of Trauma and Addiction: Addiction: Ending the Ending the Cycle of Pain Through Cycle of Pain Through Emotional LiteracyEmotional Literacy, , Deerfield Beach, Deerfield Beach, Florida, Health Florida, Health Communications, Communications, Inc.Inc.

• Napier, Nancy J., Napier, Nancy J., 1994. 1994. Getting Getting through the Day: through the Day: Strategies for Adults Strategies for Adults Hurt as ChildrenHurt as Children, , New New York, New York, York, New York, W.W. Norton and W.W. Norton and Company, Inc.Company, Inc.

DEFINITION OFDEFINITION OF POST TRAUMATIC STRESS DISORDERPOST TRAUMATIC STRESS DISORDER

• ““Persons are traumatized Persons are traumatized when they face when they face uncontrollableuncontrollable life life eventsevents and are and are helplesshelpless to affect to affect the outcome of those the outcome of those events.” (Lindemann, E., events.” (Lindemann, E., 1944)1944)

Events may include:Events may include:

… … Possible death or injuryPossible death or injury

… … Physical or sexual attackPhysical or sexual attack

… … Childhood scenes of adult Childhood scenes of adult ragerage

PTSD can result with exposure PTSD can result with exposure where: where:

• one experiences, one experiences, witnesses, or is confronted witnesses, or is confronted with events that involve with events that involve actual/threatened death or actual/threatened death or serious injury or threat to serious injury or threat to physical integrity of self or physical integrity of self or othersothers

• and reacts with and reacts with intense intense fear, helplessness, fear, helplessness, and/or horrorand/or horror (DSM lV, (DSM lV, 1994)1994)

Short Term PTSD SymptomsShort Term PTSD Symptoms

• Recurrent/intrusive memories (images, thoughts, Recurrent/intrusive memories (images, thoughts, perceptions)perceptions)

• Reliving parts of event through hallucinations or Reliving parts of event through hallucinations or flashbacksflashbacks

• Intense physiological arousal (rapid heartbeat, Intense physiological arousal (rapid heartbeat, sweating, general anxiety, stomach queasiness, sweating, general anxiety, stomach queasiness, head pounding)head pounding)

• Difficulty falling or staying asleep Difficulty falling or staying asleep • Difficulty concentratingDifficulty concentrating• Irritability or angry outburstsIrritability or angry outbursts• HypervigilanceHypervigilance• Exaggerated startle responseExaggerated startle response

Long Term PTSD SymptomsLong Term PTSD Symptoms

• Trouble with intimacy or commitmentTrouble with intimacy or commitment• Unable to set or set overly rigid boundariesUnable to set or set overly rigid boundaries• Inability to relax, have fun, be spontaneousInability to relax, have fun, be spontaneous• Difficulty with trustDifficulty with trust• Fixation on PTSD or Trauma (as if constantly Fixation on PTSD or Trauma (as if constantly

reoccurring)reoccurring)• Changes in personalityChanges in personality• Chronic depression with despairChronic depression with despair• Psychosomatic symptomsPsychosomatic symptoms• Sensation seeking or numbing behavior (high risk Sensation seeking or numbing behavior (high risk

acts or self-medicating)acts or self-medicating)

COMPLEX PTSDCOMPLEX PTSD

• This occurs due to repeated early and later This occurs due to repeated early and later experiences of chronic and/or severe experiences of chronic and/or severe traumatic events and experiencestraumatic events and experiences

• Symptoms include:Symptoms include:– Affect disregulationAffect disregulation– Destructive behavior toward self and othersDestructive behavior toward self and others– Dissociation (separating self into parts)Dissociation (separating self into parts)– Distortions in concept of self or othersDistortions in concept of self or others– Inability to use emotions as signals so misread Inability to use emotions as signals so misread

internal and external cues and significantly internal and external cues and significantly over or under react to present situationsover or under react to present situations

INTENSITY OF PTSDINTENSITY OF PTSD

Severity and long term response based on:Severity and long term response based on:• Genetic predispositionGenetic predisposition• Developmental phase (firm sense of identity Developmental phase (firm sense of identity

and strong social support helps)and strong social support helps)• Prior traumatizationPrior traumatization• Preexisting personality (e.g. untreated phobias Preexisting personality (e.g. untreated phobias

and maladaptations to previous life stressors and maladaptations to previous life stressors more likely to result in psychiatric reactions)more likely to result in psychiatric reactions)

Nazi survivors: 99% psychiatric disturbances, 87% Nazi survivors: 99% psychiatric disturbances, 87% cognitive disturbances, 85% persistent nervousness cognitive disturbances, 85% persistent nervousness and irritability, 60% sleep disturbances, 52% and irritability, 60% sleep disturbances, 52% nightmaresnightmares

UNDERSTANDING THE UNDERSTANDING THE BRAINBRAIN

• Fear, horror, and helplessness of traumatic event activates the Fear, horror, and helplessness of traumatic event activates the amygdalaamygdala (moderates hormones for flight, fight, or freeze) and (moderates hormones for flight, fight, or freeze) and basil forebrain basil forebrain (stimulates arousal and reward). This reaction (stimulates arousal and reward). This reaction evolved for human survival.evolved for human survival.

• Trauma aroused feeling states get frozen and stored as memories in Trauma aroused feeling states get frozen and stored as memories in the lower brain without any conscious thought processing. When the lower brain without any conscious thought processing. When these these memories are triggered by external associationsmemories are triggered by external associations , the , the trauma is relived physiologically and hormonallytrauma is relived physiologically and hormonally leading to leading to automatic reactions of fight, flight, or freeze (shutting down).automatic reactions of fight, flight, or freeze (shutting down).

• There is There is no conscious knowledge or awarenessno conscious knowledge or awareness of what is of what is happening because the conscious part of the brain that ordinarily happening because the conscious part of the brain that ordinarily processes and provides meaning or context has not been activated. processes and provides meaning or context has not been activated.

• Feedback loopFeedback loop: arousal triggered by environmental stimuli causes : arousal triggered by environmental stimuli causes release of stress hormones which increase anxiety, which increases release of stress hormones which increase anxiety, which increases stress and a circular loop develops, often leading to acting out stress and a circular loop develops, often leading to acting out behaviors or emotional shutdown/numbness to manage the high behaviors or emotional shutdown/numbness to manage the high levels of “physiological flooding”. This state interferes with ability to levels of “physiological flooding”. This state interferes with ability to learn and improve coping. learn and improve coping.

EMOTIONAL ILLITERACYEMOTIONAL ILLITERACY

• Lack of conscious processing of reactionsLack of conscious processing of reactions

• Feelings not “processed”: experienced, Feelings not “processed”: experienced, labeled, or communicated. labeled, or communicated.

• Interferes with development of healthy Interferes with development of healthy self-soothing and supportive relationships self-soothing and supportive relationships

TRAUMA TREATMENT TRAUMA TREATMENT GOALSGOALS

• Ensure physical and emotional safetyEnsure physical and emotional safety• Create relationships where there is safety to share Create relationships where there is safety to share

feelings and real support is consistently availablefeelings and real support is consistently available• Maintain sense of curiosity during exploration to Maintain sense of curiosity during exploration to

find new parts of self with a story to tell and find new parts of self with a story to tell and triggers with important bridges to unremembered triggers with important bridges to unremembered experiencesexperiences

• Monitor for self- frustration due to getting Monitor for self- frustration due to getting triggered and triggered and be gentle with selfbe gentle with self

• Work on how to listen to body’s distress and Work on how to listen to body’s distress and translate to feelings so symptoms have a voicetranslate to feelings so symptoms have a voice

• Remember that the Remember that the healthy adult selfhealthy adult self is a is a compassionate resourcecompassionate resource

HOW TO PROMOTE HEALINGHOW TO PROMOTE HEALING

• See PTSD when it is in front of youSee PTSD when it is in front of you• Educate about how PTSD worksEducate about how PTSD works• Manage “over or under reactive” behaviors Manage “over or under reactive” behaviors

calmlycalmly• Work toward Work toward emotional literacyemotional literacy by helping to by helping to

convert sensed feelings into words to decode the convert sensed feelings into words to decode the inner world and create meaning within selfinner world and create meaning within self

• Support communication of inner state to othersSupport communication of inner state to others• Learn to recognize triggers, separate past from Learn to recognize triggers, separate past from

present, and create a new life narrativepresent, and create a new life narrative• Help with grief work to prevent relapseHelp with grief work to prevent relapse• Use letters, journaling, emdr, psychodramaUse letters, journaling, emdr, psychodrama

BREATHING EXERCISEBREATHING EXERCISE

• Sit quietly and settle into your chair. Sit quietly and settle into your chair.

• Feel your body as it touches the chair and Feel your body as it touches the chair and your feet as they connect to the ground.your feet as they connect to the ground.

• Focus on your breathing.Focus on your breathing.

• As you breathe in, say to yourself:As you breathe in, say to yourself:

““May I dwell in the heart of healing”May I dwell in the heart of healing”

• As you breathe out, say to yourself:As you breathe out, say to yourself:

““May I heal into my full self!”May I heal into my full self!”